Archived: The Keepings

The Keepings is a residential care home providing accommodation and personal care to 19 people aged 65 and over living with dementia at the time of the inspection. The service can support up to 23 people.

People’s experience of using this service and what we found

People were kept safe and staff knew how to do so. Staff were recruited appropriately and received training, so they knew how to support people with their medicines as they were prescribed. There were sufficient staff to support people and risks to people were identified and reviewed. People received support from staff who received infection control training. When an accident or incident took place, trends were monitored.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff could access support when needed and had the appropriate skills and knowledge to meet people’s needs. People made choices as what they had to eat and drink and could access health care when needed.

People received support from staff who were caring and kind. People’s privacy, dignity and independence were promoted.

People received support that was responsive to their needs. They were communicated with in a way they could understand. Assessments and care plans were in place and reviews took place regularly so where needs changed, staff would know how to support people based on their changing needs. People could access activities that were tailored to their interests and hobbies. The provider had a complaints process in place and complaints were responded to on a timely basis.

People received support that was well led. The provider ensured appropriate governance was now in place to monitor the quality of the service, spot checks and audits were now taking place. The registered manager ensured people’s views were gathered by way of them completing questionnaires and regular meetings took place, so people were involved in the management of the service.

Rating at last inspection

The last rating for this service was Requires Improvement (Report published 22 November 2018) and there was a breach of regulation 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Keepings is registered to provide accommodation and support for up to 23 people who have conditions related to old age and/or dementia. 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. On the day of our inspection there were 21 people living at the home. 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.

Information on people’s interests, likes and dislikes were an improvement on the last inspection, the provider did not ensure these were reflected in any activities they provided.

While the provider and registered manager carried out spot checks and audits. They were not effective in identifying areas of concerns within the service. The provider did not ensure the environment was checked regularly.

Staff knew how to keep people safe and could explain the action they would take where people were at risk of harm. There were enough staff to meet people’s needs in a timely way. People who needed medicines could receive them as they were prescribed. Personal protective equipment was made available to staff so they could support people in a way that reduced the risk of cross infection.

Staff could get support when needed so they had the skills and knowledge to support people. The provider followed the requirements of the Mental Capacity Act (2005), so people’s human rights were not restricted where they lacked capacity. The provider ensured people had access to health care as required.

Staff were kind and caring in the way they supported people. Assessments were carried out so the provider could be sure they could meet people’s needs. People’s privacy, dignity and independence was respected in the way staff supported them.

Relatives and advocates were involved to support people share their views. A complaints process was in place so any concerns raised could be dealt with appropriately.

The provider made available a questionnaire to gather people’s views, but it was unclear as to how the analysis from the questions were shared with people.

We have made a recommendation about people living with dementia.

We found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.

The Keepings is registered to provide accommodation and support for 23 people who have conditions related to old age and /or dementia. On the day of our inspection there were 19 people living at the home. 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.

People told us they felt safe. Staff knew how to keep people safe from harm and knew who to contact where they had concerns. People received their medicines as it was intended on a timely basis.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which was identified as a requirement at our last inspection in September 2015. However further training was still needed to ensure staff had sufficient knowledge to protect people’s human rights.

Staff were kind and compassionate and the environment of the home was warm and welcoming. Staff were not always able to get support when needed so people’s needs were met.

People were able to make choices and decisions as to how they were supported by staff and what they had to eat and drink. People’s privacy and dignity were not always being respected.

People’s needs were assessed and a care plan put in place to show how people would be supported. However people’s preference likes and dislikes were not consistently being sought so any activities planned could involve the things people like to do.

The provider had a complaints process in place so people were able to raise concerns and they were acted upon accordingly.

The provider installed a CCTV system to support them with the management of falls prevention, however there was no evidence of consultation with people about the use of the system within the home.

The provider carried out spot checks and audits however they were not always effective in identifying areas of concern within the environment.

The provider used a quality assurance survey to gather people’s views on the service they received.

We carried out this inspection so that we could answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

From our previous inspection significant action had been taken to improve the service to people. There are still improvements to be made.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions we had with three people who lived at the home, two members of staff who supported people, the deputy manager and the registered manager. We looked at three people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that systems were in place to support learning from events like accidents, incidents and complaints. We spoke with people who told us they were able to raise concerns. One person said, "If I need to I will speak to staff or the manager".

We found that risk assessments were in place to manage any potential risks. People's care and welfare were an important part of the service people received. Our observations were that people were able to access fluids regularly throughout the day and staff were proactive in ensuring people were not dehydrated.

We found that people's medication administration record (MAR) charts were much better at showing whether people had been given their medicines and processes were in place to guide staff when using 'as required' medicines.

People we spoke with told us they felt safe living in the home. We found that there was no second stair rail to support people up and down the stairs. People clearly needed an additional rail to support them up and down the stairs and keep them safe from harm.

No applications for the Deprivation of Liberty Safeguards had been submitted by the service. Training records showed that training was available in the Deprivation of Liberty Safeguards (DoLS), but only the manager and deputy manager had completed the training. There was no record of the Mental Capacity Act (MCA) training being delivered. Staff we spoke with had a very limited understanding of both areas of training.

We raised concern with the manager about the risks to people's safety from the slightly raised flooring along the main corridor to the dining area from people tripping or falling.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is safe to meet people's needs.

Is the service effective?

We found that people's current needs were being identified through up to date reviews, so if people's needs changed staff would know how to meet their needs. Documentations were in place to highlight to staff where there were potential risks to how people's needs were being met.

Records had improved since out last inspection, but there were still some concerns with how staff recorded when they had cleaned the home and whether audits carried out by managers were effective. We found gaps in cleaning schedules, which audits did not pick up and we could not be sure that the environment was being cleaned regularly.

Systems were in place to ensure checks were carried out on the quality of the service people received. The provider ensured people were able to share their views on the service so improvements could be made.

People told us that staff were, "Caring" and "Kind". One person said, "Staff do take us out on trips regularly".

Overall we found that the provider had systems in place to ensure people's needs were being assessed and any changes to people's needs could be identified. However we asked the provider to tell us what improvements they would make to ensure audits carried out were effective.

Is the service caring?

Staff we spoke with had a good understanding of people's needs. We observed staff interacting with people in a caring and supportive manner. Staff spent time to sit and talk with people, we saw staff dancing, and having a laugh with people. Staff were constantly asking people if they were okay and checking on people in their rooms constantly to see if there was anything they wanted. One person said, "I like living here. I can do what I want and there is no fuss".

People's preferences were recorded on their care records. One person had on their record that they were a keen gardener, so staff encouraged them with gardening. People were able to take part in activities from our observations or just sit and watch the television. One person said, "I like just sitting in my room and watch the world go by".

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was caring.

Is the service responsive?

We found that from our previous inspection the provider took action as required to improve the service to people. We found that there were still areas to be improved but the provider was aware of these and actions were ongoing.

The provider listened to what people and their relatives said about the service. As a result of people's views the provider was decorating the home and having new carpet throughout. This was from a direct concern raised by people through a questionnaire.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was responsive to people's needs.

Is the service well-led?

The service was managed by a registered manager who was supportive throughout the inspection. People we spoke with told us if they had any concerns they could speak to the manager.

We found that a number of audits were regularly being carried out to ensure the service people received were of a high standard. These were not always effective in identifying areas of concern, but the manager was committed to improving the service.

The action taken by the manager to improve the environment of the home and people's bedrooms as a result of the concerns raised through the questionnaire process, showed willingness to improve the home.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was well-led.

People we spoke with told us that staff supported them appropriately and met their needs. One person told us, 'I am looked after here, the staff are good.' A relative we spoke with told us, 'I am happy with the care provided, the staff are polite, caring and lovely. It couldn't be better.'

Staff we spoke with were able to tell us about people's needs. This ensured they received support in a way they preferred.

We found that although the service had made improvements there continued to be some issues that had not been identified and addressed. This meant that risks associated with the management of medicines were not always identified.

We found that improvements were required in promoting good infection control so the risks of infection to people were reduced.

We found that some improvements had been made to ensure people's care records contained more detailed information about their care needs. There were still further improvements required to ensure these records accurately reflected people's current needs.

People we spoke with told us that staff supported them appropriately and met their needs. One person told us, 'I am fine here, I am looked after and the staff are friendly and caring.' Another person told us, 'I am happy here, the staff help me when I need them to and they are respectful.' Staff we spoke with was able to tell us about people's needs. This ensured they received support in a way they preferred.

We found that some improvements had been made with the systems for administering people's medication but further improvements are required to ensure people receive their medication as prescribed.

We saw staff had training to assist them in protecting people from harm.

We found that staffing levels had been increased to ensure sufficient staff was available to meet people's needs.

We found that arrangements were in place to identify shortfalls, and action was being taken to make improvements.

We found that accurate records were not in place to support that appropriate checks had been carried out for a staff member recently recruited to work in the home. We also found that people's care records did not contain specific information about their care needs. This meant that there was a risk that people might not have always received care that met their needs.

We found that people were involved in making care and treatment decisions throughout the day. One relative said, "I have seen the care plan to see what is in there." We saw that staff appropriately supported people to promote their independence.

We found that people had advice and treatment from other healthcare professionals in a timely manner. We found that staff were not always aware of people's care and health needs and people's care plans were not always updated. This meant that there was a risk that people might not have always received care that met their needs.

We found that there was no evidence to show that appropriate checks had been carried out for all staff before working at the home. We found that arrangements were not always in place to ensure that people were safeguarded from abuse.

We found that arrangements to ensure the safe handling of medicines were not effective. This meant that we could not be sure that people received their medicines as prescribed.

We found that there was an insufficient number of staff to care take of people's needs. One person said, 'We could do with some more staff.'

We found that systems to monitor the quality of services were not always effective at identifying shortfalls in the home.