Archived: Keswick

On the day of inspection we met 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.

The inspection was unannounced and took place on 27 June 2017.

When we last inspected the service on 17 March 2016 we highlighted shortfalls in the delivery of support to people, particularly with regards to their safety and individualised support. On 17 March 2016 we highlighted inconsistencies with the implementation of the Mental Capacity Act (MCA). We also observed that staff did not always treat people with dignity and respect. Following that inspection the registered manager sent us an action plan explaining how they were going to address the two breaches of regulation we found. During this inspection we found there had been improvements in all of these areas and all these shortfalls had been rectified.

During this inspection people felt safe at Keswick. Risks of harm to people were identified at the initial assessment of care and staff understood what actions they needed to take to minimise risks. Staff understood people's needs and abilities. There was sufficient staff to meet people’s needs.

People were supported by staff who understood the signs of abuse and their responsibilities to keep people safe. Safeguarding concerns had been appropriately reported. Recruitment practices were followed that helped ensure only suitable staff were employed at the service.

People were supported with the medicines safely. Staff were confident and had the knowledge to administer medicines safely. They knew how to support people to take their medicines safely and to keep accurate records.

People received person centred care and people were supported with activities which were meaningful to them and were in line with their interests and preferences.

Although some improvements had been made people did not always have up to date records that reflected their needs. The impact on people was low because we observed people receiving the support they needed and wanted during the inspection. We also saw that an inaccurate record was recorded on the day of inspection. This record did not reflect people’s views. We have recommended that the registered manager ensures that records reflect the support and views of people.

Staff felt they received the training and support they needed to meet people's needs effectively. Staff felt supported by the management team and there was good feedback about staff induction.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of MCA and DoLS. When people lacked capacity the best interest process was followed.

People were supported to eat meals of their choice and staff understood the importance of people having sufficient nutrition and hydration. Staff referred people to healthcare professionals for advice and support when their health needs changed.

People praised staff for their caring nature. Staff were kind and respected people’s privacy, dignity and independence. Care staff were thoughtful and recognised and respected people's wishes and preferences.

People knew how to complain and were confident any complaints would be listened to and action taken to resolve them. Staff understood the values of the organisation and this was reflected in the support we observed.

The registered manager audited the care and support delivered and sought feedback from people and relatives regarding the support received.

The registered manager understood their responsibilities in terms of notifying CQC of significant events at the service. Staff support people in line with the organisational values as support was centred around increasing people’s independence.

The inspection took place on the 17 March 2016 and was unannounced.

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.

People did not always receive safe care and treatment. Any risks people took were not always minimised. Risk assessments had not always been completed for people and staff were not always aware of people’s needs. We observed several incidents where staff were supporting people to move or transfer from chairs in an unsafe way.

People did not always receive their medicines as prescribed. During the inspection we found that people had not always received their prescribed medicine. The registered manager raised a safeguarding with the local authority regarding this and started an internal investigation. People were prescribed as required medicines (PRN); however protocols to describe to staff how, why and when the person should have these medicines were not robust. Topical creams had not been applied as directed by the person’s doctor.

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. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When people lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We did not consistently see the code of practice being applied in the service and accurate documentation being undertaken by staff. We have made a recommendation to the provider regarding this.

People were not always treated with kindness, compassion and respect. Staff did not always take time to speak with the people who they supported. We observed both good and not so good interactions between staff and people.

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people. Permanent staff had the specialist training they needed in order to keep up to date with care for people.

People were able to see their friends and families as they wanted and there were no restrictions on when relatives and friends could visit. The activities on offer to people were varied. One person said, “The pianist is excellent.”

Incidents and accident were fully investigated by the registered manager, and actions put in place to reduce the risk to people of accidents happening again such as people falling.

Care was provided to people by a sufficient number of staff who were appropriately deployed. People did have to wait to be assisted. One person said, “Staff come when you want them.”

People and their relatives gave positive feedback about the service they or their family member received. People were very happy. One person said, “Staff treat me very well.” People and their families had been included in planning the care provided. We saw that people did not have an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed.

People were provided with a choice of freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical or religious or cultural needs were provided where necessary. One person said, “It’s nice here and the food is good.”

People knew how to make a complaint. One person said, “I have not needed to make a complaint.” Complaint procedures were up to date. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished.

The registered manager undertook quality assurance process, including regular audits on health and safety, infection control and medication. The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

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

Below is a list of the summary of what we found. The summary is based on our observations during the inspections, speaking with people who used the service. the staff supporting them, and from looking at records.

For further evidence supporting our summary please read the full report.

Is the service safe?

We saw that people who used the service were treated with respect and in a dignified way by staff. We saw that safeguarding procedures were in place and staff understood their responsibilities in safeguarding the people that they cared for. Staff told us that they knew how to respond to a safeguarding concern and would inform the manager.

The service was clean, hygienic and safe from hazards, providing safe access to all areas of the home.

We looked at staff training arrangements that were in place and saw that the staff were provided with all the appropriate training to ensure safe and appropriate care was provided for the people that used the service.

We saw that systems were in place to record, report and monitor incidents and compliments. There were policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Staff we spoke to told us that they had safeguarding training and the Deprivation of Liberty Safeguarding training was part of this. This ensured that people were protected from the risk of unlawful restraint.

Is the service effective?

People`s health care needs were assessed with them and included their families as part of that process. Arrangements were in place for people to be supported by other health care professionals, and people`s opinions and views were sought as part of the review process.

Is the service caring?

We saw that people were supported by caring staff who spoke to them in a polite and respectful manner. People told us that "Staff are kind and helpful" Another told us, "I like my room, staff are doing a good Job". Another told us, "I will never go back to living alone, it is nice here".

Staff were able to tell us about the people they supported. They knew people`s individual histories and support needs without having to refer to the care records. Staff were seen to take time to talk and to listen to what people had said, and they encouraged people to be independent by encouraging them to take part in activities such as going on day trips and playing board and card games.

People`s preferences, interests and diverse needs had been acknowledged and recorded in the care records, and support provided to meet these needs and interests. Family links were maintained and family and friends encouraged to visit.

Is the service responsive?

We saw that people were involved in a variety of activities, and could participate in which ever activity they decided to. People were involved in choosing where to go for day trips. For example on the day of the inspection a group of people had been taken by the activities co-ordinator to the coast for the day. People who did not go on this occasion told us that they would be going next week and it was a destination that they had chosen.

Is the service well led?

The manager had a good understanding of the needs of the people that used the service, as well as managing the requirements of the home. Staff told us that they were clear about their roles and responsibilities, and that they had a good understanding of the values of the home and the organisation that they worked for. Care records were updated regularly to monitor the service that people received. This helped to ensure that people received a good quality service at all times.

People told us that staff asked for their permission before they undertook tasks for them. One person told us, 'Staff always ask me if I am ready to take my medication, they never just give it to me.'

Most of the people we spoke with were aware of their care plans. Some people told us they had no interest in their care plans. One person told us, 'I am well looked after. I get three good hot meals a day, a bed and plenty to do here.'

People told us that they had never had any issues or concerns in relation to their medication. They told us they knew what their medication was for and if they were not sure they would ask the staff.

People told us that they felt safe and well looked after by staff who cared about them. They told us that staff attended to them whenever they asked.

The relatives of a person who had recently moved into the home were very complimentary about the staff and how well the service was run. They told us they were pleased that they found a service for their family member with which they were extremely happy with.

We found the service to be non-compliant with one of the six outcomes we looked at. We found that there were shortfalls in relation to records maintained at the service.

People were very complimentary about the care they received from staff employed at the service. They told us that staff were very caring and they were always available. One person told us, 'Staff are always available and they come very quickly when I press my call bell.' They told us they made choices every day about their lives and how they wanted to be looked after.

We saw staff talking to people in a respectful manner and offering support as and when required. People were engaged in activities during the morning and afternoon. There was a calm and relaxed atmosphere at the service.

We noted that not all staff had received regular supervision, annual appraisals or training as required that would help them in their roles.