Archived: Ernest Kleinwort Court

Ernest Kleinwort Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can provide accommodation and personal care for up to 33 people who require support with their personal care. The service specialises in supporting younger adults with physical disabilities. There were 31 people living at the service at the time of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. On the day of the inspection, the registered manager was not present and the service was being overseen by an acting manager.

The inspection was prompted in part by notification of an incident following which a person using the service was subject to serious harm. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However the information shared with CQC about the incident indicated potential concerns about the management of weight loss. This inspection examined those risks.

Risks to people's safety had not always been adequately assessed, monitored and minimised. This included risks associated with nutrition, choking, catheter care and skin breakdown. Care staff did not consistently have oversight of people's air mattresses settings and some air mattresses were set at the incorrect setting which placed people at risk of their skin breaking down.

People were not supported in a consistent manner to live healthier lives. Poor joint working meant people were also not supported in an effective manner to receive care and support that promoted their wellbeing. Poor documentation meant the provider could also not provide assurances that people had been supported to access healthcare services.

Documentation was not always fit for purpose or accurate. Discrepancies and gaps in recording had not consistently been identified by the provider as a shortfall and consequently the provider was unable to demonstrate if people received the care required or whether it was a failure to document the care provided.

People’s care needs were not assessed in a holistic manner and staff members raised concerns that people were not always supported to meet their social and psychological needs. One staff member told us, “Activities are not strong.” Whilst end of life care plans were in place these lacked guidance and detail. This is an area of practice that needs improvement.

The principles of the Mental Capacity Act (MCA) 2005 were not consistently applied in practice. A range of restrictive practice was in place, but the care planning process failed to identify if care could be delivered in a least restrictive manner.

Systems to assess and monitor the service were in place but these were not sufficiently robust as they had not ensured a delivery of consistent high care across the service or pro-actively identified all the issues we found during the inspection.

People spoke highly of the food provided. One person told us, “It’s like going to the Savoy every day.” However, risks to people with complex care needs had not been identified or managed in relation to their eating and drinking. Risks associated with weight loss were not managed effectively.

The management of medicines was not consistently safe. Staff members felt there was blame and shame culture. Staff members felt devalued. One staff member told us, “We need strong management.” People were not consistently protected by the prevention and control of infection. A range of training was available for staff, however, staff felt training did not always provide them with the required skills and abilities. We have identified this as an area of practice that needs improvement.

People’s right to privacy was respected. Staff knew the people they were caring for very well. It was clear that permanent members of staff had built positive rapports with people. Recruitment checks were carried out to ensure suitable staff were employed to work at the service.

People's individual ability to evacuate the service has been assessed and evacuation plans were in place. Safeguarding policies and procedures were available for staff to access and people told us they felt safe at the service. A range of group activities took place and the provider employed a dedicated activity coordinator.

We found a number of breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the registered providers to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Earnest Kleinwort Court belongs to a national charity that provides care, rehabilitation and support for people with profound physical impairments, acquired brain injury and learning disabilities, as well as children and adults with autism. Earnest Kleinwort Court provides accommodation for up to 35 people, who require support with their personal care. The service specialises in supporting younger adults with physical disabilities. On the days of the inspection there were 31 people living at the service, the majority of who were wheelchair users who also had other complex needs, such as learning disabilities, autistic spectrum conditions and communication difficulties. Two people also had a mental health diagnosis.

The accommodation was purpose built and comprised of a main building which contained 21 rooms and six bedsits, plus a further three bungalows within the grounds, all of which had ensuite facilities. There was a communal dining and social area in the main building and a dedicated activities room in a separate building. The service is based in Burgess Hill, West Sussex.

We carried out an unannounced comprehensive inspection on 14 and 19 January 2016. Breaches of legal requirements were found and following the inspection the provider wrote to us to say what they would do in relation to the concerns. These included the management of medicines, the assessment of risk, safeguarding people from abuse, staffing levels and access to staff training and development. Further concerns related to care plans that did not accurately reflect people’s needs and those which contained out-of-date information. People, who were unable to take part in meetings, were not always asked their preferences with regard to the activities that were provided. There was also a lack of oversight of the service to enable the provider to ensure the quality of service being provided. At this inspection on 5 and 6 October 2016 we found that significant improvements had been made and the provider was no longer in breach of regulations. However, although systems to improve staff’s access to training and development and oversight of the service had improved, we were yet to see these sustained and embedded in practice.

The service did not have 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. The last registered manager stopped working at the service at the end of October 2015. A new manager was recruited in December 2015, but left the service in June 2016. The service was then managed by a registered manager from one of the provider’s other services until the end of September 2016. Following this, another of the provider’s registered managers, a deputy manager and an assistant manager had been seconded to manage the service for three months. They were supported by two permanent assistant managers, an administrator and team leaders and there were plans in place for a new manager to be recruited. It was evident that the changes in management over the last year had been disruptive for people who lived at the service as well as staff that worked there. However, everyone spoke positively about the leadership over recent months and felt things had changed for the better. Comments from staff included, “Everything is good, in general they are all on the ball” and “Management are amazing now. They are looking out for the residents and putting things in place to keep the residents safe and happy. We used to be left to do everything, but they’ve come in and made this place much better.”

Staff had access to the training which the provider considered essential, as well as training that was specific to the needs of people they were supporting. The manager had identified that some staff had not yet completed all of the training. Provisions had been made to ensure staff were provided with support and guidance whilst they waited for their training to be completed, ‘ten minute teaching sessions’ had been implemented during staff handover meetings to ensure that staff were updated on current good practice in relation to their roles. A visiting healthcare professional, who had been invited to attend one of the sessions, told us, “They really made me feel included. The staff really seemed to take on board what I told them. I think it gave them more confidence to follow the guidance”.

Mechanisms were in place to assure the quality of the service being provided. Quality assurance systems as well as regular audits were conducted to enable the manager to have an oversight of the service to identify areas that required development. There were systems in place to enable people to raise concerns and complaints and those that had been received had been dealt with in accordance to the provider’s policy.

People told us that they felt safe, one person told us, “The staff help me stay safe. I haven’t had a fall or anything like that. I trust them to look after me properly”. Another person told us, “I’ve always felt safe, secure and comfortable here”. People were protected from harm and abuse. There were sufficient quantities of appropriately skilled and experienced staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. When safeguarding concerns had been recognised the appropriate action had been taken to ensure peoples’ safety. People’s freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented. People received their medicines on time and according to their preferences, from staff with the necessary training and who had their competence assessed. There were safe systems in place for the storage, administration and disposal of medicines.

People were asked for their consent before being supported and staff had a good awareness of legislative requirements with regard to making decisions on behalf of people who lacked capacity. One staff member told us, “We always assume people can make decisions for themselves”. One person told us “They don’t restrict me, which is great. I can do whatever I want”. People and their relatives’, if appropriate, were fully involved in the planning, review and delivery of care and were able to make their wishes and preferences known. Care plans documented peoples’ needs and wishes in relation to their social, emotional and health needs and these were reviewed and updated regularly to ensure that they were current.

Staff worked in accordance with peoples’ wishes and people were treated with respect and dignity. It was apparent that staff knew peoples’ needs and preferences, as well as their interests and hobbies, and were able to support people to access and enjoy these. Positive relationships had developed between people and staff. One staff member commented, “It’s a jolly place to work and spending time with people is what it’s all about”. One person told us, “The staff are good. I get on well with my key worker”.

Peoples’ health needs were assessed and met and they had access to medicines and healthcare professionals when required. Healthcare professionals explained that if people were unwell then healthcare professionals were contacted promptly. People’s privacy and dignity was respected and maintained, one person told us, “They leave me alone when I want to be left, like this morning”. Another person told us “They never come into my room without knocking, it may seem minor but it means a lot to me and they will always ask my permission to go into my room if I’m not in. Staff always keep very good manners, a simple please and thank you is always followed”. People had a positive dining experience and told us that they were happy with the quantity, quality and choice of food. One person told us, “I love the food. It’s brilliant”. Another person said, “The chef is a genius. The food is so good and there is a lot of choice”.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at. During the time of our inspection there were 30 people living at the home. We spoke with six people, relatives, the manager, the management team and five care staff. We looked at four care files, six staff personal files and a number of relevant records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found care plans were comprehensive, reviewed on a regular basis and were up to date. There were individual risk assessments in place that were reviewed frequently and ensured that people who used the service were safe.

We spoke with six people who used the service and they told us that they felt safe at the home. They said that staff ensured their safety and they were able to make informed decisions about any likely risk.

We found risk assessments in place to ensure that the environment was safe for people who used the service and staff working there. There was a system in place for staff to report any incidents and learn from concerns raised to ensure the safety of people who used the service.

We found that when duty rosters were planned, considerations were taken to ensure the right skill mix and level of staff on each shift. This meant that people who used the service were supported by sufficient numbers of appropriate staff.

The Care Quality Commission monitors the operation of Deprivation of Liberty Safeguards (DoLS). While no applications had been submitted, appropriate policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found during our inspection that the service was effective. This was because the service provided people with clear and sufficient information about what services were available to them prior to moving into the home. We found that people were involved in the process of their assessment and they told us they were made aware of the care and treatment they would receive from the service. People we spoke with told us that they had control over their lives and were able to dictate what was appropriate for their individual needs. We found that people were able to give valid consent to the care and treatment they received.

A high proportion of people who used the service required individual support with mobility; such as manual and electric wheel chairs, hoists and assistive technology. We found this equipment was maintained to a good standard and assessments were carried out to ensure that equipment was suitable to meet individual needs.

Is the service caring?

We found that the service was caring. We noticed that each person had a personalised care plan that was reviewed on a regular basis. People we spoke with told us about the level of input they had in their care planning and how the management was reactive to their change in needs. This ensured the care and treatment they received were appropriate to their needs.

People we spoke with and their relatives told us the following: 'They do care about you here and staff are there when you need them', 'I am left to get on with my life as I want', 'Staff are respectful to you and my key worker is also my friend', 'X the manager is very kind and helpful', 'They are very good, caring and always welcoming'. This reflected that people who used the service and the representatives felt that staff were caring, respectful and met their needs.

We observed that staff were courteous, treated people as individuals and treated them with respect. They ensured that people who used the service were supported in maintaining their dignity as well as living life independently.

Is the service responsive?

We found that the service was responsive. They had a system in place to deal with concerns and complaints. Where people had raised any concern or complaint, we found that the service had responded to them in a timely fashion and taken appropriate action as required. People we spoke with were aware of the complaints procedure in place. They felt that their views were taken into consideration and acted upon accordingly.

We found that there was a range of activities on offer at the home and most of them were initiated from people's individual interests. We saw displayed pictures of various events that people had taken part in such as sailing, cooking, BBQ and, day trips. People we spoke with told us that they were supported in pursuing their hobbies or other areas of personal interest. They said that the activity co-ordinator and the management would ensure that they had access to employment and other relevant opportunities within the community.

Is the service well-led?

During the inspection we found that the service was well led. People we spoke with told us that there was an open culture within the home and they were consulted as and when required.

We saw the outcome of the survey carried out in March 2014 by the provider to people who used the service, relatives and professionals. We found the overall response to be positive about the quality of service delivered. Where there had been queries raised within the survey, we found that the manager had responded to them appropriately and action taken to ensure that people's views were acted upon to improve the service.

We found that the management had notified the Care Quality Commission and the local authority Safeguarding Agency of notifiable incidents that needed reporting in a timely fashion. We were told by the manager that these incidents were discussed during team meetings and they would learn from these outcome to improve the service and prevent further risk. We saw that the home had various audit tools in place to ensure that the quality of service was maintained to a good standard and was consistently safe.

Staff we spoke with told us that they had very good support from the management, were able to express their views and felt that they were listened to.

One person told us 'It's pretty good here. Food is excellent.' People told us that they received good care and that their key worker assisted them with any issues they needed to resolve. People told us that staff understood their needs and that they provided appropriate care and support. One person said 'Staff are really good.' We observed that staff were responsive when people asked for assistance and offered people choices about how their care was provided.

The people we spoke with told us that they felt safe living at the service. Care plans provided guidance to staff on how the person should be supported safely. Staff had been trained in the safeguarding of vulnerable adults and records showed that the service had co-operated with other agencies to safeguard people.

Staff who were employed were supported and trained to meet peoples' needs. One person said 'Staff understand what I need.' The service took account of peoples' views on how the service was provided and people told us that things they had suggested in residents' meetings such as improvements to the environment had been acted upon. The service monitored the quality and safety of the service provided and took action where needed.