Background to this inspection
Updated
21 March 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This focused inspection took place on 21 February 2019 and was unannounced. The inspection was conducted by two adult social care inspectors.
Before the inspection we reviewed the information which was held on Kemp Lodge. This included notifications we had received from the provider such as incidents which had occurred in relation to the people who lived at the service. A notification is information about important events which the service is required to send us by law. We also contacted the local authority safeguarding team. We used all of this information to plan how the inspection should be conducted.
During our inspection we spent time talking with the clinical lead, the HR manager, the compliance lead, three members of care staff and four people who lived at the service.
We looked at care records belonging to four of the people living at the home, a sample of medication administration records, policies and procedures and other documents relevant to the management of the service.
We also undertook general observations of the service over the course of our inspection.
Updated
21 March 2019
This inspection took place on 21 February 2019 and was unannounced.
Kemp Lodge is registered to provide nursing and personal care for up to 38 people. At the time of the inspection there were 15 people living at the service. A large proportion of people had already left the service or were in the process of moving to alternative accommodation. Kemp Lodge is a purpose built single story building consisting of three units and provides care to adults with nursing and personal care needs. The service is set in pleasant grounds in a residential suburb of Liverpool.
Kemp Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
At the time of our inspection a registered manager was in post. A registered manager is a person who has registered with CQC 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 inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because at the last inspection, the service was not meeting some legal requirements.
No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing 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 for this inspection.
This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 12 December 2018 had been made, when the service was rated as ‘Requires Improvement.’ This is because breaches of legal requirements were found in relation to ‘Safe Care and Treatment,’ ‘Safeguarding’ and ‘Good Governance,’ which are breaches of Regulation 12, 13 and 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.
Services rated as ‘Requires Improvement’ will be inspected again with 12 months. Prior to our inspection in December 2018, the registered provider had applied to CQC to remove the location and the service was due to close in February 2019. However, the provider had recently extended the date for closure until June 2019. Given that the service was due to remain open later than originally planned, we decided to conduct a focused inspection. We needed to consider any current risks and how the provider has mitigated them appropriately and the impact on people using services and whether the provider remains in breach of requirements.
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 of safe and well-led. At this inspection, we checked to see whether the provider had acted on our findings from the last inspection and what action had been taken to resolve them.
When we completed our previous inspection, we found concerns relating to ‘Safe care and treatment’ and ‘Good governance.’ This was because systems in place to manage topical medication, thickening agent and PRN medication (as and when required medication) were not being properly managed and systems to manage the quality and safety of the service were not always effective. This was a breach of Regulation 12 and 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014.
At the last inspection, we looked at safeguarding records and found that the service did not always appropriately identify safeguarding concerns and notify us of concerns. This meant people were exposed to the risk of actual or potential harm. This was a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities Regulations) 2014.
During this inspection we found that although a number of improvements had been made, the registered provider still remained in breach of ‘Safe Care and Treatment,’ ‘Safeguarding’ and ‘Good Governance.’ To improve the rating from ‘Requires Improvement’ the service requires a longer-term track record of consistent safe practice and sustainability of governance.
We looked at care records belonging to four people. We saw that people’s care requirements were identified and people were appropriately referred to external health professionals when required. This helped to maintain people’s health and well-being. However, we also found that care plans did not always consistently record the most up to date information throughout. This meant that people were at risk of not receiving the care and support they required.
During our inspection we found a number of fire doors did not close properly and some fire doors and exits had been wedged open. This meant they would be ineffective in the event of a fire and placed people at risk.
Most people we spoke with told us they felt safe living at Kemp Lodge. Staff understood their responsibilities in relation to safeguarding people from abuse and mistreatment and could explain how they would report any concerns.
We looked at how accidents and incidents were reported in the service and found they were managed appropriately. Accident/incident reports were monitored by the registered manager and regional manager for any trends or patterns.
We found there were enough staff on duty to meet people’s needs. Some people using the service had fed back to management that they didn’t always feel there was enough staff on duty. The service responded by increasing staff numbers.
Feedback about the current registered manager of the service was positive. There were a range of comprehensive audits in place which identified issues and recorded action taken to resolve them. However, action had not yet been implemented to address the repeated concerns we found during our inspection in relation to consistency of information contained in people's care records.
The ratings from the previous inspection were displayed prominently as required.