Archived: Korniloff

We undertook an unannounced, focused inspection of Korniloff on 23 and 24 April 2018. The team inspected the service against two of the five questions we ask about services: Is the service Safe and Well Led? This is because we had received concerns from the local authority and safeguarding team about people’s care at Korniloff.

Korniloff 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.

Korniloff is a residential care home providing accommodation and personal care for older adults. The service is set in a converted hotel on the coast, offering spacious communal areas to make the most of the wide stunning views of the sea and Burgh Island. The service does not provide nursing care. The home uses community nurses to provide this service. The home can accommodate a maximum of 17 people but as the provider does not use two rooms as doubles, the actual capacity is 15 people.

At the time of the inspection 12 people were living at Korniloff, one person was in hospital. The provider was also the registered manager who lived on site. 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 received concerns from the local authority safeguarding team. These included concerns about; poor and neglectful personal care, poor care in relation to management of people’s skin and risk of falls, poor medicine management, failure to recognise and respond effectively in response to changes in people’s health needs, environmental concerns and concerns about the leadership at the service.

A safeguarding meeting had taken place with the local authority prior to the inspection and we were told a number of safeguarding investigations in relation to these areas of concern were on-going. We did not look at these specific investigations as part of the inspection, however, we did use this information to inform us about how we needed to conduct the inspection and areas of care we needed to consider and review.

The local authority had also informed us prior to the inspection, that due to the high number of concerns received, they had met with the provider and requested an improvement plan and assurances about people’s safety. Due to the concerns, the provider and commissioners agreed to stop any admissions to the home. The provider also agreed to stop admitting any privately funded people.

We found the systems in place to keep people safe from harm were poor. There were not good medicine practices in place. Staff had not been trained to administer medicines and had little knowledge of why people were on particular medicines. There were no medicine audits in place and no individual protocols about how people should receive their medicines. We found people did not always have their medicine at the right time, some had missed their medicine and some had too much medicine given to them. These were areas of concern.

People’s risks were not known, documented or well managed at the service. People at risk of falls, weight loss or skin damage were not assessed. Skin care management was poor and inconsistent. People were not repositioned frequently and did not always have the equipment they needed to help prevent skin breakdown.

Accidents were recorded but no one reviewed accidents and incidents which had occurred. This meant opportunities to analyse and prevent risk were missed.

People were at risk from staff that had not received a thorough induction, training and ongoing monitoring of their skills. Some staff had not received medicine training, fire training and moving and handling training. This affected their practice in these areas and put people at risk.

Staffing levels were not always safe. The provider did not have a dependency tool to assess what safe levels of staffing should be.

The environment was not safe and presented risks to people.

The leadership at the service was ineffective. Communication within the service was poor. People at the service did not have opportunities to suggest ideas and raise their views.

Quality assurance processes were minimal and did not drive change.

Following the inspection we took immediate action to ensure people were safe. We told the provider to give us assurances that people were safe in relation to medicines, moving and transferring, staffing levels, management of falls and skin care and the security of the property. The provider worked closely with the local authority to provide us with assurances within the timescale requested.

However, during the course of the inspection, the provider gave notice to the local authority commissioners to end their contract. The provider also submitted an application to the Commission to cancel the registration of the service. This meant they would no longer be providing care to people. Following the inspection, on 4 May 2018 the local authority confirmed to the Commission all people had been moved from Korniloff.

At the last inspection in August 2016 the service had required improvement in some areas. These had included staffing levels, medicine administration, timely referral to health professionals and ensuring effective quality assurance audits were carried out. Risks to people’s safety and their care needs were assessed during that inspection, but this information was not always transferred to care plans. At that time people’s care plans were not comprehensive and were not reviewed regularly. This meant staff did not always have the most up to date information on people’s needs. People had also told us they would like the opportunity to go out of the service on a regular basis, which had not been happening.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. The manager, who had been in post for nearly a year, had ensured that the above issues had been addressed. As the provider lived on site and they were intending to move away from day to day management, their input had become less systematic which did not always ensure actions were completed in a timely way. The manager had now arranged for more formalised regular monthly meetings with the provider and information such as maintenance management had been centralised to ensure there was not information held by the manager and also the provider which could be confusing.

People lived in a service which had been designed and adapted to meet their needs. The provider and manager had taken into consideration people’s diverse care and support needs when making changes to the environment, and listened to what people needed. People lived in an environment which the provider had assessed to ensure it was safe and had taken appropriate actions. As an old style building, maintenance work was on-going. People were protected by the provider’s infection control procedures, which helped to maintain a clean and hygienic service.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. Staff and the manager were very knowledgeable about people’s needs and how they liked to spend their day. People were able to choose what they wanted to do, maintain their independence as much as possible and enjoyed spending time with the staff who were visible and attentive. Most people currently had a low level of need and were able to communicate well, were independently mobile and sometimes only required the assistance of one care worker. People’s individual equality and diversity was respected, enabling people to be supported in the way they wanted to be.

People looked comfortable and happy to spend time in the large hotel type lounge, TV area and conservatory looking out to sea. People were encouraged and supported to maintain their independence. Most people were over 90 years old and told us they were happy living at the home. They enjoyed a more quiet morning sitting together chatting or watching TV and in the afternoons we saw people enjoying playing a game with staff. People were engaged with staff, receiving visitors, watching what was going on, pottering around the spacious communal areas or spending time in their rooms.

People and relatives said the home was a safe place for them to live. One person was able to tell us, "I’ve nothing to say, it’s all fine. We have a nice quiet life which I like.” Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Relatives said they would speak with staff if they had any concerns and issues would be addressed. People and relatives knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One relative said, “I come all the time and my relative is very happy here. They are all very nice and I come for tea.”

People were well cared for and people and their relatives had opportunity to be involved in planning and reviewing their care; most people chose not to be involved as they were “happy with things as they were.” Staff had good knowledge about people, including their backgrounds, needs and preferences. Care plans had been updated to reflect a more person centred approach which reflected staff knowledge of people’s individual needs. People were able to make choices, for example about what drink they would like, including from the ‘Korniloff bar’ or what clothes to choose and when to go to bed or get up.

There were regular reviews of people's health, and staff responded to changes in need. For example, care records showed examples of staff identifying changes in need and appropriate referrals to health professionals. The manager had organised a more effective way to capture health and short term needs to ensure this information was gathered in one place to inform staff. District nurses visited daily and told us they were happy with the care that was delivered. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

People were supported at the end of their life to have a comfortable, pain free and dignified death. The service was not always a ‘home for life’ as the manager was clear about ensuring the service could continue to meet people’s needs should they increase considerably or referring people to appropriate health professionals. They worked with local health professionals ensuring people received individualised palliative care and pain relief promptly. Following a recent death, staff were attending the funeral with other people living at the home and the family had shown their appreciation of the staff during end of life care.

Medicines were well managed and stored in line with national guidance.

Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. The staff team was stable over the last year and some care staff had worked at the home for some years and knew people very well, having built up meaningful relationships. They said they enjoyed the homely feel and felt they were well supported by the manager.

People’s privacy and individual equality and diversity was respected, enabling people to be supported in the way they wanted to be and staff promoted independence. Staff pro-actively supported people to keep in touch with family and friends, inviting friends and family to coffee mornings and events regularly. The relative told us they were always made welcome and were able to visit at any time, use the quieter lounges and were offered hot drinks. People were able to see their visitors in communal areas or in private.

The manager and deputy manager showed great enthusiasm in wanting to provide the best level of care possible and valued their staff team. For example, they were purchasing vintage tea stands to offer afternoon tea parties, looking into staffing to enable a trip to the local aquarium and encouraged relatives and staff to visit with their families as people enjoyed seeing their children. Staff had adopted the same ethos and enthusiasm and this showed in the way they cared for

people in individualised ways. Staff thought about ways they could further support people, for example by offering a trip out to one person’s favourite café or placing visual reminders for people who lived with short term memory along their usual route around the home.

Observations of meal times showed these to be a very positive, relaxed experience in a lovely setting, with people being supported to eat a meal of their choice where they chose to eat it.

There were now quality assurance processes in place to monitor care and plan on-going improvements, overseen by the provider. There were systems in place to share information and seek people's views about the running of the home, including relatives and stakeholders. All responses were positive from the last quality assurance questionnaire. People's views were acted upon where possible and practical and included comments such as, “I am very happy at Korniloff. I always feel I am treated with respect and my dignity is always looked after” and “Staff are easy to get on with.” A relative had commented, “It’s a lovely, caring, family style home” and “Always a great visitor experience with friendly staff. A real home from home for grandma. We had a cream tea and bunting and they are very welcoming and helpful.”

A notice board showed events such as the monthly conservatory community coffee morning and stalls run by a local society at Korniloff. Overall, people told us th

This unannounced inspection took place on 10 August 2016. The service was last inspected on 12 February 2014 when it was meeting the regulations in place at that time.

The provider for Korniloff is an individual and therefore does not require 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. However, the provider has employed a ‘home manager’ to manage the service on a day to day basis.

Prior to the inspection we had received concerns relating to care of people living at the service. These concerns had related to the staffing levels at the service, which it was felt, had an impact on the care being provided. There were also concerns over the administration of medicine following a change of dosage made over the telephone. There were further concerns that staff had not contacted healthcare professionals when people’s health needs had changed, because some staff had not been confident in seeking their advice. Safeguarding meetings had been held and changes to practice had been made.

There was no effective quality assurance system in place to monitor care and plan on going improvements. Some audits were undertaken and some issues had been identified, such as the need for an extra toilet and bathroom. However, no plans had been drawn up to address these matters.

Risks to people’s safety and their care needs were assessed, but this information was not transferred to care plans. This meant staff did not have instructions on how to manage the risks and meet people’s needs.

People’s care plans were not comprehensive and were not reviewed regularly. This meant staff did not always have the most up to date information on people’s needs. However, the home manager was reviewing all care plans at the time of the inspection.

People’s needs were met by ensuring there were sufficient staff on duty. However, we have recommended that staffing levels are kept under review. This was because no domestic staff were employed and staff were responsible for cleaning the service and dealing with laundry. This also meant that there was limited time for staff to engage in meaningful activities with people. People told us they would like the opportunity to go out of the service on a regular basis. Following the inspection the provider wrote and told us they had recruited extra staff and were continuing to recruit in order to improve staffing levels.

People’s medicines were managed safely and healthcare needs were well managed. People were supported to maintain a healthy balanced diet and were offered regular drinks and snacks.

Robust recruitment procedures were in place to minimise the risk of staff being employed who may be unsuitable to work with vulnerable people. People were protected from the risks of abuse and people told us they felt safe at the service.

People were supported by staff who displayed a good understanding of the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People’s needs were met by kind and caring staff, who were knowledgeable in how to care and support them. People’s privacy and dignity was respected and all personal care was provided in private. People were asked for their consent before staff provided personal care. People told us they were happy with the care they received. One person told us “We get very good care”. Following the inspection one relative wrote to tell us ‘My brother and I have nothing but praise for the staff and their wonderful care that Mum has received’. People told us their visitors were made welcome at any time.

Staff told us they were well supported by the home manager and felt there was an open an honest culture within the service. One staff member told us “You can’t solve anything if you try to hide it, you have to learn from things”.

People were confident that if they raised concerns these would be dealt with quickly by the home manager.

We have made recommendations relating to staffing levels, the environment and meaningful activities.

We found a breach 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 this report.

We saw that people were receiving the health and personal care they needed and wanted. Care plans had been re-written to reflect people's needs and wishes regarding their care. People told us 'We love it here. We count ourselves very lucky to have found here. We think all the staff are wonderful and nothing is too much trouble for any of them" and said 'I would like to put on record how wonderful the staff have been. I can't praise them highly enough.'

People's medication was being given out in accordance with the prescribing instructions and there were enough care workers on duty to support people well. We saw that the home was keeping the required records, although some of these needed updating. It was not clear that proper records and risk assessments had been undertaken to protect people against the risks associated with wooden stair gates at the top or foot of staircases.

We talked with seven people who lived at the home, two relatives, four members staff and the manager. People said they were happy living at the home and that the care staff looked after them well. One person said "They (the staff) are brilliant. They always make sure we are alright and that we have everything we need and more. I really couldn't say enough about them."

People told us that they felt involved in their care. However people were not always involved in development and review of care plans. We found that care plans were not person centred.

The home offered a number of different activities. We saw that people were laughing with staff and told us that they enjoyed the activities.

People told us they felt safe. The home had a policy on safeguarding and the staff were able to tell us about different types of abuse and how to raise an alert.

Staff received training, supervision and appraisal. Staff told us that they felt supported and were knowledgeable about peoples care needs.

The home had some audit processes in place for checking the quality of the service.