This inspection took place on 9 and 19 June 2015 and was unannounced. At the last inspection on 16 July 2014 we found the provider was breaching regulations in relation to medicines management, staffing and supporting staff. After that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. At this inspection we checked whether the provider was now meeting these legal requirements, as well as others as part of this comprehensive inspection.
Kew House is registered as a care home for up to 81 adults. It provides accommodation for people who require personal care and nursing. At the time of the inspection there were 61 people living at the home. The home was divided into three units across three floors, which were each called ‘a community’. There was a dementia community on the middle floor which offered nursing support for people with dementia. The top floor was for older people who required nursing care and the ground floor was for people with a lower level of needs and who required personal care.
There was no registered manager in post, although the manager had applied to be registered with Care Quality Commission (CQC) and was awaiting the outcome. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
At this inspection we found that the action taken by the service to improve medicines management was insufficient to keep people. They did not always receive their medicines as records indicated and were not always protected against the risks associated with the medicines.
We found the improvements required in relation to previous breaches of legal requirements in staffing and supporting workers had been made. There were sufficient staff deployed to meet people’s needs and the provider regularly assessed and adjusted the required staffing levels. Staff received sufficient supervision to support them in carrying out their roles. In addition, we found staff received the training they required. Staff training needs were regularly monitored and a training programme was in place. Recruitment procedures were robust in checking staff were suitable to work with people who used the service.
The manager and senior managers monitored accidents and incidents in the home to look for patterns and check people received the right support. Risks in relation to individuals, such as moving and handling and bed rails were well documented and regularly reviewed to check risks were being managed appropriately. People were involved in planning their care and care was delivered as people wished.
Staff understood how to safeguard people from abuse and they received regular training in this subject. The home reported allegations of abuse to CQC and the local authority safeguarding team as required. They carried out investigations where relevant and shared information with the local authority as part of keeping people safe.
The premises and equipment were safe and well maintained with a range of regular health and safety checks carried out. A cooling system was being installed during our inspection to regulate the temperatures as the provider had identified sometimes they became too high.
Staff understood the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The service was meeting their requirements to keep people safe under DoLS.
People received the right support to eat and drink and they had choice in what they ate. Staff supported people to have their health needs met, arranging visits from a range of health professionals when needed.
Staff were caring and treated people with dignity and respect. People’s needs in relation to dementia were met in a caring way with the input of the organisation’s dementia specialist. Visitors were able to visit at any time as visits were unrestricted.
An activity programme was in place on each community and activities were provided based on people’s interests. Activities were provided each day such as baking, musical performances, exercises, quizzes and flower arranging to meet people’s social and recreational needs.
Systems were in place for effective communication within the service including regular meetings for staff, people using the service and relatives. People were encouraged to provide feedback on their experiences and to raise concerns. Complaints were investigated and responded to appropriately. Staff were encouraged to raise concerns not only within the home, but with senior managers. There were arrangements to facilitate and enable whistle-blowers through the use of an independent organisation which anonymised the person raising the concern.
A range of audits were carried out by managers, senior managers, consultants and specialists in different areas to monitor and assess the quality of the service. Action plans were put in place to improve where the audits identified concerns. However, the action plan put in place following our previous inspection was insufficient in relation to medicines. Records in relation to wound management were not always appropriately maintained which meant that people were not always protected against the risks of inappropriate care and treatment arising from this.
We have taken action against the provider for a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we will report on it when our action is completed. Regarding the second breach of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014, you can see what action we told the provider to take at the back of the full version of the report.