Kenrick Centre Also known as Delroy Bonnitto

Kenrick Centre is a care home that provides personal care for up to 64 people. At the time of the inspection 45 people lived at the home. The accommodation was established over two floors. On the ground floor there was a residential unit where 22 people lived, and on the first floor there was an enablement service where 23 people stayed at the time of our inspection visits.

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

Improvements had been made since the last inspection in March 2019 when Kenrick Centre was rated Inadequate. Systems had been put in place to keep people safe. However, further improvements were needed to meet the legal requirements and the provider needed to be assured the improvements made so far will be sustained, remain embedding and further improved.

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Systems in place to manage risks to people were not always robust. How staff had consulted with people about their care and the outcome of these discussions had not always been recorded. To show people had been involved in agreeing their care and treatment.

People were supported to receive their medication as prescribed. Staff demonstrated a good knowledge of types and signs of abuse and how to report concerns of abuse. People were supported to access healthcare professionals when required.

Staff felt supported and told us that the service was well managed, and many improvements had been made since our last inspection. Improvements had been made to the training and support staff received so they had the skills and knowledge to meet people’s needs.

The registered provider had a system in place to ensure any complaints received would be recorded, investigated and responded to and any learning used to improve the service provided.

People's dietary needs were met, and people had access to healthcare services where required so they were supported to stay well.People were supported by staff who were caring. People were involved in decisions around their day to day care and were treated with dignity.

The registered provider had systems in place to identify and support people's protected characteristics from potential discrimination. Protected characteristics are the nine groups protected under the Equality Act 2010. They include, age, disability, race, religion or belief etc.

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 Inadequate (published May 2019) and there were multiple breaches of the regulations. The registered provider completed an action plan after the last inspection to show what they would do and by when to improve.

During this inspection the registered provider demonstrated that improvements have been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. However, the provider was still in breach of regulations and further improvements were needed to ensure the regulations are met.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified continued breaches in relation to regulation 12 safe care and treatment and regulation 17 Good Governance.

Follow up

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

The Kenrick Centre also supplied the local community with day centre facilities, a café and a gym which were available for people to use. CQC do not regulate these types of service, so our inspection did not look at this aspect of the Kenrick Centre.

People's experience of using this service

•Risks which affected people’s health and wellbeing were not always documented and staff did not always have adequate information to manage and mitigate against risks to people.

•Medicines were not stored or managed safely, which put people at risk.

•Infection control procedures required improvement to ensure people were protected from the risk of infection and cross contamination.

•Staff did not always receive up to date information and training, to ensure they knew how to support people safely.

•Systems of audits did not effectively identify where improvements were needed.

•The leadership and governance of the service required improvement to ensure lessons were learnt, and improvements were embedded and sustained into practice, so that people received a good quality service.

•Care records were not always up to date, and did not always show who should be consulted about decisions regarding people’s care and finances.

•People were not always able to participate in activities, interests and hobbies that met their individual needs and choices.

•People told us they felt safe with staff who supported them.

•There were enough staff to meet people’s assessed needs across both units.

•Staff had completed safeguarding training and knew what to do if they were concerned about people’s well-being.

•People were supported to make daily living choices such as what they wanted to eat, and where they wanted to spend their time.

•Staff were aware people’s needs could change, and understood when to seek advice and involve other health care professionals and services when needed.

•Staff knew people well, and knew their preferred ways of communicating, to assist people to make choices.

•Staff encouraged and supported people to be as independent as possible.

•There was a registered manager in post on each of the units at the centre.

•Feedback from people and staff was sought to identify where improvements could be made in the delivery of service.

Rating at last inspection: Requires Improvement. The last report for Kenrick Centre was published on 16 January 2018. CQC had inspected this service on four previous occasions, a rating of Requires Improvement had been awarded on all the previous inspections.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The inspection was also prompted in part by notification of a potential serious incident. At the time of our inspection, we were conducting an ongoing investigation. Whilst this inspection did not examine the circumstances of the incident, we considered the provider’s management of risks; staff training, and quality assurance procedures. We may review our findings in more detail when the ongoing investigation is concluded.

Enforcement: The service met the characteristics of Inadequate in two key questions of safe and well-led, with Requires Improvement in effective, caring and responsive.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the provider. The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC.

The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any 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 act to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

At the last inspection in December 2016 the provider was rated as requires improvement in two out of the five areas we inspected against; whether the service was safe and well- led. This was because medicines were not always managed effectively to reduce any associated risks to people and the systems in place to assess and monitor the quality of the service were not always used to identify where improvements were needed.

During this inspection, we found that some improvements had been made; however further improvements were required.

The Kenrick Centre is a purpose built centre which is designed to accommodate up to 64 people across two separate services. On the first floor there is an enablement service which provides support for up to 32 people for up to four to six weeks following discharge from hospital. The purpose of the enablement unit is to provide a further period of recovery and assessment to prepare people for their return home or identified placement. The ground floor is registered to provide accommodation and personal care for 31 people. At the time of our inspection 56 people were living at the service. Changes were required to the registration of the service to reflect that people were receiving accommodation and personal care as part of the enablement service on the first floor. The provider has been informed of this and we await applications to make the necessary changes to their registration.

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. There were two registered managers in post at the time of our inspection, one on each of the two units whom were responsible for running the two services separately and independent of the other.

The service was not consistently safe or well-led because the management team had not always fulfilled the responsibilities of their role. The provider’s quality assurance systems had failed to identify the shortfalls found during the inspection and some of the improvements required at the time of our last inspection had not been made. These included issues related to the safe management of medicines within the home as well as sufficient oversight of auditing practices such as fridge temperatures and Deprivation of Liberty Safeguard (DoLS) authorisations.

We have made a recommendation about the management of medicines within the home.

Some people felt that more staff were needed to meet their needs in a timelier way. The provider was in a period of transition whilst staff from other locations were being transferred over to work at the Kenrick Centre. Staff shortages were managed using agency staff that were deployed on a regular basis to promote consistency.

Most of the people we spoke with felt safe living at the home and were protected from the risk of abuse and avoidable harm. The provider had effective systems in place to ensure that staff were recruited safely, received the training they required and were aware of the safeguarding processes in place.

People were cared for by staff who had been trained to meet their needs and who obtained their consent prior to supporting them. People were offered choices on a daily basis which included meal preferences. This meant that people had food that they enjoyed and any risks associated with their diet were identified and managed safely within the home.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary.

The service was caring because people were supported by staff that were helpful and caring. Staff had taken the time to get to know people including their personal histories, likes and dislikes. People were also cared for by staff that protected their privacy and dignity and respected them as individuals.

People were encouraged to be as independent as possible and were supported to express their views in all aspects of their lives including the care and support that was provided to them, as far as reasonably possible. Most people felt involved in the planning and review of their care.

People had the opportunity to engage in activities within the home, but these were not always specific to their individual interests. People were supported to maintain contact with people who were important to them and visitors were welcomed at any time.

There was a structural approach to the leadership within the home and staff reported to feel supported by the management team.

The Kenrick Centre is a purpose built centre which is registered to provide two types of service.

On the first floor there is an enablement service which provides personal care for 32 people for up to four weeks following discharge from hospital. The purpose of the enablement unit is to provide a further period of recovery and assessment to prepare people for their return home or identified placement. The ground floor is registered to provide accommodation and care for 31 people. At the time of our inspection 59 people were living at the service.

A registered manager is required to manage this service. The provider had chosen to register two managers for this service. There were two registered managers in post at the time of our inspection one for each of the units. 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 systems in place to audit the quality of the service were not always effective because they did not identify where improvements were needed. Medicines were not always managed effectively to reduce the risks associated with them. Although issues raised at our inspection action was taken to address them. These issues had not been identified through the day to day auditing of the service.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and supervision to support them in their role. Staff training was monitored and opportunities were provided to staff to further develop their knowledge and skills. Sufficient staff were employed to provide care and support to people and ensure their needs were met.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and supervision. Staff training was monitored and opportunities were provided to staff to further develop their knowledge and skills. Sufficient staff were employed to provide care and support to people and ensure their needs were met.

People told us that People had been involved in decisions about their care and received support in line with their care plan.

People were supported to maintain good health and had regular access to healthcare professionals. They had enough to eat and drink and individual dietary needs were met where needed.

People were encouraged to pursue interests, hobbies and activities that were of interest to them. People told us that they felt confident that any concerns they raised would be dealt with.

On the day of our inspection there were 29 people who used the enablement service and there were 29 people who lived in the residential home.

In the enablement service we spoke with 15 people, two relatives and looked at five sets of care records. We also spoke with four members of staff and the registered manager.

In the residential home we spoke with 6 people who lived there, three relatives and looked at four sets of care records. We also spoke with four members of staff and the registered manager. Some of the people who lived at the home were unable to verbally express their views to us. To help us understand how their experience of care, we spent time observing how staff delivered their care we also looked at care records and spoke with relatives and staff.

People's privacy, dignity and independence were respected. One person told us, 'You are encouraged to do as much as for yourself as possible. It shows you can help yourself, so the enablement service is working'

Care was planned and delivered to ensure people's safety and welfare. One person told us, 'I get the care that I need and when I need to see the doctor they are called without delay'.

Safeguarding procedures were in place to identify the possibility of abuse and preventing abuse from happening.

Medicine management systems were in place so that people had their medicines as prescribed by their doctor to ensure their health and wellbeing.

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard. One person told us, 'Staff are always polite, always helpful'

Gaps and inconsistencies in people's care records meant that people were not protected from the risks of unsafe or inappropriate care because accurate and appropriate records were not consistently maintained.

On the day of our inspection there were twenty seven people using the service. We spoke with twelve people and four relatives. We also spoke with the registered manager, three members of staff and two health care professionals. We looked at three sets of care records for people using the service.

People's privacy, dignity and independence were respected. However, improvements were required in the way that people using the service and those acting on their behalf were involved and informed of their care.

Lack of appropriate care plans and risk assessments meant that care was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

Safeguarding procedures were in place to identify the possibility of abuse and preventing abuse from happening.

Arrangements were in place to manage medicines, however improvements were required in the way that medicines were stored.

Staffing levels were adequate to meet people's needs, however there was a lack of training for staff.

People were not protected from the risks of unsafe or inappropriate care because accurate and appropriate records were not consistently maintained.