Kentwood House

Kentwood House is a care home providing accommodation with personal and nursing care to up to 32 people. The service provides support for people with complex nursing needs including people living with dementia. At the time of our inspection there were 11 people using the service. The accommodation is arranged across two floors with lift access.

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

There had been improvements in the recording of risk to people and assessments which reflected people's choices since our last inspection. The provider still needed to improve the detail on people's mental capacity assessments. More detailed guidance would be beneficial on specific health needs such as diabetes or anxiety and depression to enable staff to have detailed information to be able to support people in the most effective way.

Risks to people had been identified and staff were able to demonstrate knowledge of people's needs. They understood and demonstrated that people's wishes and preferences in how they wished to be supported were respected.

People were supported to minimise the risk of infection. Staff wore appropriate Personal Protective Equipment such as gloves, masks and aprons when completing people's care and the service was clean.

Staff demonstrated knowledge of the different types of abuse people may be at risk of and told us what action they would take if they suspected someone was a victim of abuse or neglect.

The numbers of safely recruited staff met the needs of people in the service and we observed caring, respectful and kind interactions between staff and people using the service.

Medicines were managed safely, and medicines administration records were completed. Stocks of medicines were correct and stored safely.

People told us that staff were kind, attentive and friendly. We observed positive culture between staff and people using the service and people all knew who the provider was and that they were approachable. Staff were responsive to people’s changes in need and supported them the way they wished to be supported.

The provider was open and honest during inspection. They were receptive to suggestions made during the inspection and will update the CQC with progress of these regularly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 January 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 05 October 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, governance and person-centred care .

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kentwood House on our website at www.cqc.org.uk.

Enforcement

We have identified a continuing breach of regulation in relation to records within the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kentwood House is a care home providing accommodation with personal and nursing care to up to 32 people. The service provides support for people with complex nursing needs including people living with dementia. At the time of our inspection there were 21 people using the service. The accommodation is arranged across two floors with lift access.

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

Risk assessments had not consistently identified and managed risks to keep people safe. Incidents had not been reported and there was no evidence investigations had been undertaken or any lessons had been learned. There were limited systems in place for checking environmental risks and some checks had not been documented, for example, window restrictors and emergency lighting.

People did not always receive care and support that was person centred. Care plans lacked detail about peoples’ personal choices, preferences and wishes. There were no meaningful activities happening in the service. One relative said, “There needs to be more for them to do.”

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

The provider did not have robust quality monitoring processes in place to identify and address any shortfalls and where checks or audits had been undertaken, these did not identify issues found during our inspection.

Medicines were managed safely, and medicine administration records were completed. The service was clean, but some areas had worn carpets and paint chipping from walls. Visiting to the service was restricted and people still needed to make appointments.

People and their relatives told us they felt safe living in Kentwood House, and they were happy there. One person said, “I feel safe here because I am with other people.” Another person said, “I feel perfectly safe here. There is always someone walking around, and the manager wanders around.” One relative said, “[Relative] is happy, they really like it there and I like it there too.” Another relative said, “[Relative] is safe here, the carers are very nice, and they know what they are doing.”

Staff treated people with dignity and respect and people told us staff were kind and friendly. Staff were mindful of peoples’ privacy and confidentiality. Staff told us they had done training online, had supervision meetings and the provider was supportive. Staff were happy working in Kentwood House. People, relatives and staff told us the provider was approachable.

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

Rating at last inspection

The last rating for this service was good (published 23 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this report. We have identified breaches in relation to safe care and treatment, person centred care and good governance at this inspection. You can see what action we have asked the provider to take at the end of the full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Staff provided nursing care for up to 32 older people. Kentwood House is a family run ‘care home.' People in care home services 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. The accommodation spanned two floors and some rooms had on-suite facilities. A lift was available for people to travel between floors. There were 16 people living in the service when we inspected. People had longer-term health issues associated with ageing or illness requiring nursing care.

We carried out our last comprehensive inspection of this service on 28 March and 07 April 2017 and we gave the service an overall rating of ‘Requires Improvement.’ At that inspection we found two breaches of the legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014 and one breach of the legal requirements of the Health and Social Care Act Registration Regulations 2009. The breaches related to Regulation 12, Safe Care and Treatment and Regulation 18 Notifications of incidents. We also made five recommendations. The recommendations related to the management of Legionella risks, planning for foreseeable emergencies, the presentation of policies, the management of the Mental Capacity Act 2005, specialist staff training and the legal requirements placed on the provider to send notifications to CQC.

The registered provider sent us an improvement action plan telling us how they intended to meet the legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014 and the Health and Social Care Act Registration Regulations 2009. They told us they would meet the regulations by 31 August 2017. At this inspection we found improvements had been made. The regulations had been met and the recommendations had been acted on.

There was a registered manager employed at the service. 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. The registered manager and the registered provider both worked at the service.

Since our last inspection the system for managing incidents and accidents had been improved. These were recorded and checked by the provider to see what steps could be taken to prevent incidents or accidents happening again. The risk was assessed and the steps to be taken to minimise them were understood by staff. The improvements included a protocol for notifying CQC and/or the Local Authority Safeguarding Team when required.

General and individual risks were assessed and management plans implemented by staff to protect people from harm. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred.

The registered manager and care staff used their experience and knowledge of people’s needs to assess how they planned people’s care to maintain their safety, health and wellbeing. The risk from infection from waterborne illness [Legionella] had been minimised.

All staff had now received training about the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The provider had reviewed key policies including those that covered the planning of foreseeable emergencies.

Staff had received specialised training in relation to the management of challenging behaviours. Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills.

The provider had a system in place to assess people’s needs and to work out the required staffing levels. The registered manager and lead nurse led on the effective delivery of nursing care. End of life care plans were developed with specialist nursing support. People had access to food, snacks and drinks during the day and at night. People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept, assisting staff to monitor and maintain people’s health.

We observed safe care. Staff had received training about protecting people from abuse and understood their responsibilities in preventing abuse. Nursing staff understood their professional responsibility to safeguard people.

Staff were welcoming and friendly. Activities were planned to keep people mentally active and maintain skills or hobbies. People and their relatives described staff as friendly and compassionate. Staff delivered care and support calmly and confidently.

Staff upheld people’s right to privacy and to choose who was involved in their care and people’s right to do things for themselves was respected. People, their relatives and health care professionals were often asked about their experiences of the service.

There were policies about equality, diversity and human rights. There were policies in place to assist people if they wanted to make a complaint about the service.

There were policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the home. This included checking nurses’ professional registration.

The premises and grounds were adapted to suit people’s needs and safely maintained. The management and staff delivered care in line with the provider’s care ethos. Plans to further improve the quality of care and premises were being developed by the provider.

The home provides accommodation, nursing and personal care for up to 32 older people, some of whom may be living with dementia. The nursing and care was provided in an environment designed to meet people’s longer term needs. Accommodation was provided over two floors with a passenger lift available for moving between floors. There were 20 people living at the home at the time of our inspection.

A registered manager was employed at this home. 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.

At our last inspection 27 May 2016, we gave the home an overall rating of, ‘requires improvement’ and ratings of requires improvement in the responsive and well led domains. Although we did not find any breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, we found that the registered manager needed to make improvements. Complaints had not been formally recorded and regular audits of the quality of the home were not taking place.

At this inspection, there had been some improvements, but we found other areas that breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Health and Social Care Act 2008 (Registration) Regulations 2009. The fire risk assessment did not identify any additional protections needed for people who may not be able to evacuate the premises quickly. For example, personal emergency evacuation plans and horizontal evacuations. We have referred this to the fire service. Incidents and accidents were recorded and checked by the registered manager, but the actions that could be taken to prevent the incidents reoccurring had not been recorded. The registered manager and provider had not reported incidents of potential harm to the local authority or CQC.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. Nursing staff understood their professional responsibility to safeguard people. However, reportable incidents had not been appropriately reported and investigated and the potential risk from legionella had not been fully assessed. We have made a recommendation about this.

There were a range of policies in place governing how the home should be run, but these were not kept updated. We have made a recommendation about this.

The provider and registered manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the home had been tested and well maintained. However, the emergency policy was not specific to the home. We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care were generic and did not cover individual elements of their care. We have made a recommendation about this.

Staff received support and supervision and a range of training that related to the needs of the people they were caring for. Nurses were supported to develop their professional skills maintaining their registration with the Nursing and Midwifery Council (NMC). However, the registered manager had not ensured that additional training had been provided for challenging behaviour. We have made a recommendation about this.

The registered manager was also the provider and had maintained responsibility for the delivery of the nursing and care within the home. However, they had delegated the responsibility for the overall operation of the home. The delegated person, needed to broaden their knowledge and experience of running the home to enable them to better understand their duties and responsibilities. We have made a recommendation about this.

There were policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely.

Nursing staff assessed people’s needs and planned people’s care. The risk of providing care was assessed and the steps to be taken to minimise them were understood by staff. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the home. This included checking nurse’s professional registration.

The registered manager had ensured that they employed enough nursing and care staff to meet people’s assessed needs. A robust agency back up system was in place. The provider had a system in place to assess people’s needs and to work out the required staffing levels. Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively and the registered manager provided nurses with clinical training and development.

We observed staff that were welcoming and friendly. People and their relatives described staff as friendly and compassionate. Activities were available to keep people active. Staff delivered care and support calmly and confidently. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.

If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with.

People were supported to eat and drink enough to maintain their health and wellbeing. They had access to good quality foods and staff ensured people had access to food, snacks and drinks during the day and at night.

People had access to qualified nursing staff who monitored their general health, for example by testing people's blood pressure. Also, people had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Health and Social Care Act 2008 (Registration) Regulations 2009. You can see what action we have told the registered provider to take at the back of the full version of the report.

Kentwood House is registered to provide accommodation for up to 32 people who require nursing or personal care. At the time of our inspection there were 23 people using the service. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found that improvement was required because complaints were not formally recorded and investigated within the timeframes set in the provider’s complaints procedure. Regular audits had also not been carried out to monitor the quality of the service and the care provided to ensure it was of high quality.

People using the service said they felt safe and were well cared for. Safeguarding adults procedures were in place and staff understood how to safeguard the people they supported. Risks to people were assessed and monitored, and guidance was available to staff on how to safely manage these risks.

Medicines were safely stored and administered within the service and there were arrangements in place to deal with foreseeable emergencies. There were enough staff on duty to safely meet people’s needs and recruitment checks had been made on staff before they started work for the service.

Staff had undergone an induction when starting work and had received appropriate training to ensure they had the skill required for their roles. Staff were also supported in their roles through regular supervision.

Staff sought consent from people when offering them support and the registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had enough to eat and drink and enjoyed the meals on offer. They had access to a range of healthcare professionals when needed and were involved in making decisions about their care and support.

Staff treated people with dignity, kindness and consideration. People's privacy was respected.

People were provided with information about the service when they joined in the form of a 'service user guide' which included details of the provider’s complaints policy.

People were involved in their care planning. The care and support they received was personalised and staff respected their wishes and met their needs. Care plans provided clear information for staff on how to support people using the service. They were reflective of people's individual care needs and preferences and were reviewed on a regular basis. People were supported to be independent where possible, for example by attending to some aspects of their own personal care.

Staff were knowledgeable about people’s individual needs. They were committed to offering people a good service that improved the quality of their lives There were a variety of activities on offer that met people’s needs. People’s cultural needs and religious beliefs were recorded to ensure that staff took account of these areas when offering support.

People knew about the service’s complaints procedure and said they believed their complaints would be investigated and action taken if necessary. They spoke positively about the management of the service and staff told us the management team were available to support them when needed. People and their relatives were provided with opportunities to provide feedback about the service. However improvement was required to demonstrate that people’s feedback was used to drive improvements within the service.

We spoke with five people using the service about their experience of life at the home. Also a visitor. People were positive about staff, comments included, 'Staff are good" and " I like the home and am happy with my care".

We observed staff consulting people, gaining their consent before carrying out personal care or treatments. They were professional and friendly in their interactions with people, demonstrating skill and empathy in their approach. Two activities coordinators were employed to provide daily social activities. The activities coordinator on duty at the time of the visit was engaging people in one to one and group activities. Records showed staff were suitably trained and supported, ensuring delivery of safe and appropriate care.

Emergency procedures were in place. These minimised the risk of peoples' care needs not being met in the event of emergencies, for example a fire or power failure. Risk assessment and risk management activities ensured the safety and security of the environment.

People told us that they had no complaints and were happy with the home and their care. They told us that if they had a concern or complaint they would inform a member of staff or the manager. Systems were in place to respond to comments and complaints.

During the visit registration issues were discussed and will be dealt with separately with the provider.

People spoke about the activities they liked doing and said that there was a good choice of activities on offer.

People we spoke to said that they were happy living in the home and that they enjoyed activities such as bingo and doing puzzles. Comments included 'I am happy' and 'I like playing cards'.

People we spoke to told us that they liked the meals provided, comments included 'the food is beautiful' and 'there is plenty to eat'.

Staff we spoke to told us that they could speak to the manager at any time if they were unhappy about anything at the home.

Staff we spoke to said that they enjoyed working at the home and received the training and support they needed to do their jobs. Comments included 'We all work as a team' and 'I can go and speak to the manager at any time'.