We carried out an inspection of Kenton Hall Nursing Home on 24 and 25 August 2017. The inspection was unannounced. We last inspected this service on 8 April 2015 and at that time we rated the service as Good.At this inspection, due to issues with responsiveness to call bells, food on offer, record keeping and governance we have rated the service as Requires Improvement.
Kenton Hall Nursing Home can accommodate up to 60 people. Accommodation is provided on two floors of en-suite single bedrooms. A passenger lift provides access to both floors. At the time of the inspection there were 59 people using the service.
The service had 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.
The systems in place to keep people safe had been maintained. Staff had a good understanding of the safeguarding process. Accidents and incidents were well recorded and monitored to determine if any trends were occurring. Staffing levels were based on the needs of people who used the service, and were reviewed regularly to ensure safe levels. Safe recruitment processes, including pre-employment checks had been followed.
Medicines were administered by trained staff who had their competencies to administer medicines checked regularly. Medicine administration records were well completed. The home was clean and staff followed infection control procedures. We were able to easily access potentially harmful cleaning products, but the registered manager told us they would ensure these items were securely stored in future. Health and safety checks were completed however we noted fire testing had not been carried out as frequently as detailed in the provider's safety schedule.
Staff training was up to date. Staff received regular supervision and an annual appraisal.
Feedback about the food on offer was negative. It was described as processed and bland. The registered manager explained they were working towards making improvements to the meals provided.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Applications had been made for Deprivation of Liberty Safeguards (DoLS), where it was considered that people would be unable to keep themselves safe if they were to leave the home unaccompanied.
People had access to a range of healthcare professionals to maintain their health and wellbeing. The service had very good links with the local GP practice and was part of an initiative to reduce hospital admissions. A GP and a specialist nurse visited the service at least weekly to carry out ‘ward’ rounds. Healthcare professionals we spoke with, who visited the home regularly, were very positive about the care provided at the service.
People told us staff were warm and caring. We observed that staff knew people, their needs, and their relatives well. Relatives popped in and out of the home during our inspection and were made to feel welcome by staff.
Some people who used the service did not have English as a first language. Staff had sourced translation aids, bought DVDs filmed in their first language, and held parties and special meals in the home to celebrate events which were important within their culture. People's privacy, independence and right to a private life was promoted. The service had bought a double bed for one person so their partner could stay overnight in the home.
People and relatives told us the call bell was not always responded to in a timely way. We monitored the call bell during our visit and found most calls were answered within five minutes, but that some did take longer than this. People's needs were assessed and care plans were in place describing to staff how those needs should be met. However we found care planning and record keeping in relation to people's fluid intake was poor.
People were very positive about the range of activities on offer in the home, and the registered manager told us they had worked hard to introduce more varied activities to the home such as electronic reading devices, virtual reality and arts and crafts. These were well received.
Complaints had been responded to in line with the provider's policy, however we found assurances provided within responses to complaints had not always been well monitored. The registered manager carried out a scheduled of audits, and completed regular reports to the provider. However the quality assurance system had not been robust enough to identify and address the shortfalls which we found during the inspection. The provider had also failed to record evidence of their own quality visits to the home.
Feedback about the registered manager from staff and healthcare professionals was very good. They described the home as having strong leadership. The registered manager and staff had worked hard to maintain strong links with the local community and businesses.
We found one breach of the Health and Social Care Act 2008. This related to good governance. You can see what action we told the provider to take at the back of the full version of the report.