Archived: Kearsney Manor Nursing Home

Kearsney Manor 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.

Kearsney Manor provides accommodation and nursing care for up to 47 older people who have nursing needs and who may be living with dementia. The bedrooms are located on two floors and accessed by a lift. There are communal rooms on each floor. The gardens are well maintained with scenic views and parking is available. On the day of the inspection there were 44 people living at the service.

There was 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.

We last inspected Kearsney Manor on 4 and 5 April 2017, we found ongoing breaches of the regulations and the service was rated ‘Requires Improvement’ in all domains. There was a lack of sufficient guidance for staff to follow to show how risks were mitigated including when supporting people with behaviour, moving people and managing health conditions. There was a lack of safe and effective systems to ensure that people's medicines were managed as safely as possible. There were not enough staff to meet people’s needs. People were not always treated with dignity and respect. Checks and audits were not effective. Feedback from people and staff had not been used to improve the service. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Although the provider had made improvements regarding treating people with respect they The provider had not met all of the previous breaches of regulations and further breaches were found.

When people first moved into the service a ’14 Day Care Plan’ was completed, which contained basic information regarding how to support people. Staff told us these were updated as and when staff knew more about people, however, we found that they were in place for several months after people had moved in. Although this was completed with people and their loved ones these 14 Day Care Plans lacked essential information to ensure people received the support they needed. For example, one person was living with epilepsy and their care plan contained no information regarding this. They had experienced seizures whilst living at the service, but staff were unable to tell us what the person’s seizures may look like or when they should seek further medical advice. The person had been prescribed emergency medicine when they had a seizure, but no one was trained to administer this.

Risks relating to people’s care and support were not effectively managed. Some people’s skin was damaged and they used pressure relieving equipment. There was a lack of oversight regarding this equipment and we found multiple instances where it was not set correctly, leaving people at risk of their skin breaking down further. Similarly, some people used oxygen, and there was a lack of oversight regarding the cleaning of people’s oxygen filters, and this was not consistently happening as required.

Staff did not always recognise and report incidents that had left people at risk of harm. People had become trapped in their bedrails, and although nursing staff had recorded this in their handover document the registered manager had not been informed, and no one had recognised the potential seriousness of these incidents. No action had been taken to reduce the chance of it happening again. The registered manager did not collate and analyse accidents and incidents to look for trends or patterns.

Medicines were not managed safely. When people came to live at the service, they were requested to bring their medicines from home, until the service was able to order medicines from the GP. One person had been given medicine bought in from home, that they were no longer prescribed or needed. Staff had not always followed procedures for medicines with specific storage and administration requirements. Staff had handwritten some people’s medication administration records (MARs) and these had not been checked to ensure they were correct. Staff had not taken action when the temperature where medicines were stored was too high. There were no charts to show staff where to apply the creams, how often and sign to record when they had.

We started our inspection early, at 7am as we had received concerns from whistleblowers that there was not enough staff at night. Although we found that there was enough staff to meet people’s basic care needs, people told us that during the day they were bored and there was not enough staff to keep them engaged. Staff were kind and cared about people, however they were focused on ensuring people’s basic needs were met and as such were task led. There was no activities co-ordinator and therefore a lack of formal activities occurred day to day. Information was not always presented to people in an accessible format.

The provider’s vision for the service was to, ‘Provide a warm homely and caring environment, where staff feel valued and we acknowledge and embrace the uniqueness of each resident, whose individual physical, emotional and spiritual well-being needs are met.’ Although this was the case, people did not always receive person-centred care. Staff used one person’s thickening powder for everyone who needed their fluids thickened, even though this was individually prescribed. People were not using incontinence aids designed for their individual needs as they were waiting for continence assessments to be completed.

Only one nurse and the registered manager had been trained to administer a syringe driver, which is used to administer medicine to keep people pain free at the end of their life. There was a risk people may have to wait to receive this medicine if these members of staff were not immediately available.

The provider and registered manager lacked oversight. This was the first nursing home that the registered manager had run. Checks and audits had failed to identify the shortfalls found at this inspection. People, relatives, staff and stakeholders feedback had been sought in January 2018, and although this had been analysed many of the issues we identified, such as a lack of staff to ensure people were engaged had not been rectified, four months on. Staff were not always recruited safely. The registered manager had failed to notify CQC of important events that had happened in the service, as required by law. Complaints were documented and responded to in line with the provider’s policy.

The registered manager had sought advice from the local safeguarding and commissioning teams and worked with them closely. They had listened and acted on any advice given, however, this had still not ensured compliance with the fundamental standards and regulations. Staff had sought advice from a range of healthcare professionals when people’s needs had changed, to support people to live healthier lives.

Care staff had received the training they needed to carry out their roles. Staff received regular supervision and an opportunity to reflect on their role. The registered manager had recently introduced a new role to assist people to eat and drink throughout the day. Food appeared home cooked and appetising.

The registered manager had applied for Deprivation of Liberty safeguards when people were unable to consent to living at the service. 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.

Since our last inspection the service had renovated to increase the communal space available for people to enjoy. The building had been adapted to meet people’s needs, including a large lift and specialist bathrooms. The service was clean and people were protected from the spread of infection.

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 dem

Kearsney Manor Nursing Home is a care home operated by Sisters of the Christian Retreat, a Roman Catholic order. The service provides accommodation for persons who require nursing or personal care for up to 47 older people who have nursing needs and who may be living with dementia. The bedrooms are located on two floors and accessed by a lift. There are communal rooms on each floor. The gardens are well maintained with scenic views and parking is available. On the days of the inspection there were 44 people living at the service.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run.

We last inspected this service in April 2016. We found significant shortfalls in the service. The provider did not have sufficient guidance for staff to follow to show how risks were mitigated when moving people and managing behaviours that might challenge. Environmental risk assessments had not been updated, a legionella test had not been completed. Accidents and incidents had not been analysed to identify any patterns or trends to reduce the risk of them happening again. There was a lack of safe and effective systems to ensure that people’s medicines were managed as safely as possible. Staff were not recruited safely. The staff training programme was not up to date, staff had not received regular supervisions and appraisals. The service was not working within the principles of the Mental Capacity Act 2005. There was a lack of oversight of the service, quality assurance systems were in place but no quality assurance surveys had been sent since 2014.

We asked the provider to provide an action plan to explain how they were going to make improvements to the service. At this inspection we found that some improvements had been made. There were, however, three continued breaches in regulation in the safe management of medicines, guidance to staff to mitigate risk and using feedback to improve the service and staffing.

People’s medicines were not managed and recorded accurately. People received their medicines when they needed them.

People told us that they felt safe living at the service. However, not all risks assessments gave detailed guidance on how to manage risk including how to support people with behaviours that challenge.

There were not sufficient staff consistently on duty, to provide safe, effective and person centred care. People told us that staff did not always treat them with dignity and respect, they felt this was due to not having sufficient numbers of staff on duty.

There were systems in place to receive feedback from people, relatives and staff. Feedback received had not been acted on to improve the service. Checks and audits completed were not effective as they had not identified the shortfalls found at this inspection.

The Care Quality Commission is required to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the last inspection, not all staff had received mental capacity training and not all mental capacity assessments were in place. There was a lack of information to show that people had agreed to their care plan.

At this inspection, there had been some improvements. People and their relatives had agreed to their care plan and decisions that had been taken were made in people’s best interests. The registered manager had applied for DoLS authorisations when required and staff had an understanding of the Mental Capacity Act.

Improvements had been made in the recruitment of staff and their development. Staff were recruited safely and received training to perform their roles. Staff received supervision and appraisals to discuss their development. We made a recommendation that nurses receive training in how to supervise staff and complete appraisals.

Staff told us that the management team and nurses were approachable. There was a culture of openness within the service; however, staff felt that their views were not always taken into consideration.

Staff assisted people with their daily routine and were attentive while they were with people, encouraging conversations about areas of interest.

Care plans included people’s preferred routines, their wishes, preferences and abilities. Care plans were reviewed and if people became unwell or their health deteriorated the staff contacted their doctors or specialist nurses.

People told us that they felt safe living at Kearsney Manor Nursing Home. Staff received safeguarding training and were aware of how to recognise and protect people from the risk of abuse. Staff knew about the whistle blowing policy and they were confident they could raise concerns with the registered manager or outside agency if needed.

There was an activity programme of in house and outside activities for people to enjoy. This included visits by the activities co coordinator to people who remained in their rooms.

People told us they were satisfied with the meals. People had a choice of food and specialist diets were catered for. Staff understood people’s likes and dislikes, dietary requirements and promoted people to eat a healthy diet.

People and their relatives said they were able to raise complaints with the staff and registered manager, who would listen and take any action if required.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

We found three continued breaches and an additional 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.

Kearsney Manor Nursing Home is a care home operated by Sisters of the Christian Retreat, a Roman Catholic order. The service provides accommodation for persons who require nursing or personal care for up to 45 people who have nursing needs and who may also be living with dementia. The rooms are located on two floors accessed by a lift. There are communal lounges on each floor. The gardens are well maintained with very scenic views, and parking is available. On the day of the inspection there were 44 people living at the service.

There was a new registered manager working at the service. 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 and associated Regulations about how the service is run.

People told us that they felt safe living at the service but not all risks assessments showed how risks were being managed, such as how to support people with their behaviour. Environmental risk assessments had not been updated since 2012 and although the service had new boilers, a legionella test had not been completed to ensure the water was safe. Health and safety checks and maintenance checks were regularly carried out. Accidents and incidents had been recorded, but some accidents had been recorded in the wrong place. They had not been summarised and analysed to look for patterns and trends and to reduce the risk of them happening again.

Recruitment processes did not fully meet the requirements of the regulations because prospective staff’s conduct at their previous employment had not always been verified. There were gaps in employment histories, which had not been discussed and checked when the staff had been interviewed. There were sufficient staff on duty to make sure people received the care they needed.

Checks on the fire system had been made on a regular basis, however regular fire drills had not been carried out to ensure that all staff were included, and had a clear understanding of what action to take in the event of a fire.

There was a lack of safe and effective systems to ensure that people’s medicines were managed as safely as possible

The training programme was not up to date and staff had not received refresher training to ensure they were aware of current practice. The induction training was not linked to the recommended guidance for training for care staff. Nursing staff had not received clinical supervision and care staff had not been receiving regular one to one supervision meetings with their line manager. The registered manager told us that the programme of staff supervision had lapsed and action was being taken to address the issue but this had not started at the time of the inspection. It had also been recognised that annual appraisals had not been completed therefore a new system of appraisal for all staff was in the process of being implemented. Staff told us that there had been staff meetings but these were not always recorded to show what had been discussed or who attended the meetings.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection the registered manager had applied for a DoLS authorisation for four people who were at risk of having their liberty restricted. Not all mental capacity assessments were in place to assess if other people needed to be considered for any restrictions to their freedom. Not all staff had received mental capacity training and did not have a clear understanding of how restrictions may be applied to people in their best interests.

There was a lack of information to show how people had agreed with the care being provided. Records did not show how people had been involved in their care planning and consent forms had not been signed to show that they had agreed with the care being provided.

The complaints procedure was on display to show people the process of how to complain, however details required updating in line with current legislation. People, their relatives and staff felt confident that if they did make a complaint they would be listened to and action would be taken.

There was a lack of oversight and scrutiny of the service. The shortfalls in the service had only been recognised in March 2016 even though some were historic and a plan was in the early stages of being implemented at the time of the inspection. The management structure had been reviewed to support the registered manager to achieve the improvements. Audits and checks of the service were carried out but there was no action plan in place to show timescales for improvement or who was responsible for these actions.

Although there were systems in place to gather feedback about the service, there had been no quality assurance surveys sent to people, relatives, staff and health care professionals since 2014. There were no resident/relatives meetings in place to ensure people had an opportunity to voice their opinions and be more involved in the service.

Care plans included people’s preferred routines, their wishes, preferences and skills and abilities. There were review meetings to discuss people’s current support and make any necessary changes in their care. If people were unwell or their health was deteriorating or changing the staff contacted their doctors or specialist services.

There was a programme of in house and outside activities for people to enjoy. This included visits by the activities co-ordinators to people who remained in their rooms and found it difficult to engage in activities. Staff were familiar with people’s likes and dislikes, such as what food they preferred.

People told us that they felt safe living at Kearsney Manor Nursing Home. The majority of staff had received safeguarding training and they were aware of how to recognise and protect people from the risk of abuse. Staff knew about the whistle blowing policy if they needed to raise concerns about their colleagues and they were confident they could raise any concerns with the manager or outside agencies if needed. There were systems in place to make sure people were protected from financial abuse.

People and relatives told us the staff were kind and respected their privacy and dignity. Staff supported people to remain as independent as possible and helped them with their daily routines.

Staff were attentive and the atmosphere in the service was relaxed and inclusive and people appeared comfortable in their surroundings. Staff encouraged and involved people in conversations as they went about their duties.

People told us that they enjoyed their meals. People had choices of food, and specialist diets were catered for. Staff understood people’s likes and dislikes, dietary requirements and promoted people to eat a healthy diet.

Staff morale was high and they told us that they were supported by the management team. They said the managers and nurses were approachable and that there was a culture of openness within the service. They told us they were listened to and their opinions were taken into consideration.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

We found a number of breaches 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

At our inspection we found that people's records were kept up to date, reviewed and amended to reflect people's ongoing and changing needs so people received the care they needed.

People's nutritional needs were met because specialist diets were catered for.

There were systems in place to manage people's medication so that they received it when they needed it. We noted that there were two occasions where staff had not signed to say that people had received their medication which meant that not all medicines were recorded accurately.

Staff received training appropriate to their role so people could be confident they were cared for safely.

There were policies and procedures in relation to safeguarding the people who lived in the home. The manager and staff were aware of their responsibilities to ensure that people were protected from the risk or potential risk of harm.

Is the service effective?

A robust assessment and care planning process resulted in people receiving the care they needed.

It was clear from what we saw and what staff told us that they understood people's care plans and that they knew people well. People told us that they felt staff knew and understood their needs.

We looked at the management of staffing levels, and found that the home had the correct numbers of staff on duty as allocated on the rotas. There was however no robust procedures for analysing the numbers of staff on duty and was based on the managers' knowledge of the people who lived in the home. When we spoke with people and looked at the comments received in response to a recent survey we found that people felt they sometimes had to wait before staff could either respond to their call bells or assist them in the mornings. This impacted on people's perception of the availability of staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. There were proper policies and procedures in place to ensure people's rights were protected.

Is the service caring?

People we spoke with told us that they thought staff were, 'Very good', 'Respectful' and, 'Caring'. They told us that, 'Nothing was too much trouble'.

People were given ample choices with regard to their meals and when they moved in to the home they were asked about their choices and preferences so that they could have meals they enjoyed.

People were asked about their likes, dislikes, preferences and choices so they could make decisions about how they wanted to spend their day.

Is the service responsive?

Records showed the service responded to changes in people's health needs and made referrals to other professionals when needed. Specialist health care needs such as skin integrity or diabetic needs were clearly identified so that people would receive the care they needed.

There was an accessible complaints procedure. It was clear about whom people could take their concerns to in the home, there was no information about contacting an independent organisation such as the ombudsman should people feel their concerns had not been acted on. People we spoke with, however, told us they did not have any complaints but would be confident in telling the manager and staff if they had any issues they wished to raise.

Quality assurance surveys were sent out which invited people to make comments about the service. We saw that suggestions and comments had been acted on. For example an improved pathway had been laid in the gardens to make them more easily accessible for people with poor mobility.

Is the service well led?

The manager took an active role in the home. She knew each person well and took time to talk with people to find out how they were. We saw that people were comfortable talking to the manager and staff and were happy to express their opinions.

Quality assurance processes were in place to check on the quality of the service as well as the safety of the service to ensure people received safe care.

Accident and incident reports were being completed fully and were analysed to identify any trends or patterns so as to reduce the likelihood of reoccurrence.

There were a range of policies and procedures in place that gave staff guidance about how to carry out their role safely.

The staff told us that consent for care and support was obtained by people using the service or their representatives during discussion about the care and support the person needed. We saw signatures confirming people's agreement within the care plans.

Friends, relatives and visiting professionals told us that staff at Kearsney Manor were kind, considerate and "could not do enough" to help the people who used the service.

The home was clean and tidy. There was a fresh atmosphere throughout. People living at the home and relatives agreed that there were high standards of cleanliness. One person commented 'Kearsney Manor is excellent in all aspects. They treat my relative with compassion and as an individual and the home is always spotlessly clean.'

The service had enough staff with the right qualifications and skills to meet the needs of the people they provided care for. One person told us 'I cannot fault the professionalism of the care given at the home.'