Keller House Residential Care Home

We carried out an unannounced comprehensive inspection at Keller House Residential Care Home on the 24 Mach 2015 where we found improvements were required in relation to safe care and treatment and person centred care, staff training, record keeping and quality assurance.

This was an unannounced inspection, which was carried out on 26 July 2016, to check that the provider had made improvements and to confirm that legal requirements had been met. We found improvements had been made, but additional work was required to ensure the provider was meeting the regulations.

At the time of this inspection the local authority had an embargo on admissions to the home pending improvements to the delivery of care and support needs for individuals and record keeping.

The registered manager was present during the inspection. 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.

Quality assurance and monitoring systems were in place and the registered manager said audits were used to review all aspects of the services provided, although we found these were not as effective as they should be. For example, they did not identify the concerns we found with regard to medicines.

Medicines were managed and given out safely. However, systems for recording additional prescribed medicines and ensuring medicine administration records (MAR) were completed appropriately were not in place.

Staff understood people’s needs and provided the support and care they wanted in a kind and patient way. Risk assessments had been completed to identify where people may be at risk. Staff demonstrated a clear understanding of the steps that were in place to ensure risk to people was reduced, whilst enabling them to make choices and be as independent as possible.

Staff had attended relevant training, including safeguarding training, and relevant policies were in place. Staff had a clear understanding of types of abuse and what action to take if they had any concerns.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. DoLS applications had been requested to ensure people were safe and advice had been sought to from the local authority.

People were assessed before they moved into the home to ensure staff could meet their needs and care plans were developed for this information. Staff said they had read these, they felt they had a good understanding of people’s needs and provided the support and care they wanted in a kind and patient way. Care plans were reviewed and people and their relatives were involved in discussions about the care and support provided.

People said the food was very good, choices were provided and drinks and snacks were available throughout the day. Systems were in place to monitor the amount people ate and drank, to ensure they had a nutritious diet, and staff contacted the GP if they had any concerns.

There were enough staff to provide the support people needed and the recruitment procedures ensured only suitable people worked at the home. There was a relaxed atmosphere in the home, people said they were comfortable and relatives were confident that if they had any concerns the staff and manager would address them.

We spoke with three of the people who lived at the home. However, some people were not able to tell us about their experiences of living at Keller House, because of their complex needs. People told us they were comfortable and that they had nothing to complain about. One person said, 'Everything is very good here. The staff look after us and there is nothing to complain about. I could talk to the staff if I wanted to'.

We spoke with the manager, the deputy manager and two care staff. We looked at the complaints policies and procedures, the complaints records and the medication records and care plans of the people concerned.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found that during our inspection the service was safe. We saw that people were relaxed and comfortable sitting in the lounge, or walking around the home. Staff said they had a good understanding of people needs, and demonstrated how they provided the support that people wanted.

Systems were in place to ensure the management and staff learned from the complaints and concerns raised, and some of the issues identified at the last inspection had been addressed.

Is the home effective?

We found that during our inspection the service was effective. People's health and social care needs had been assessed, and they had been involved in this process, with the support of relatives or representatives.

Is the service caring?

We found that during our inspection that the service was caring. We saw that people were supported by kind, patient staff.

Is the service responsive?

We found that during our inspection that the service was responsive. We saw evidence that when people had raised concerns the manager and staff responded.

Is the service well-led?

We found during our inspection that the service was well led. Staff we spoke with were clear about their roles and responsibilities. They said they were able to talk to the management if they had any concerns, and felt very well supported by the manager and senior staff.

We saw that staff knew people well and had a good understanding of people's needs. Care plans were in place and these reflected the assessed needs of people. Staff knew what abuse was and what to do if it was suspected. There were sufficient numbers of staff with the appropriate skills to meet the needs of people using the service. There was a complaints procedure in place, however the systems in place to manage complaints did not ensure complaints were fully investigated or resolved to the satisfaction of the person making the complaint.

We found that the service monitored quality in a number of ways. They obtained feedback from people who used the service and their relatives using questionnaires. The comments we saw were positive and included, 'very clean and homely' and we are 'quite happy' with the support.

A number of audits had been introduced and these included the management of medicines, staff training, care plans and suitability of the environment. We found that the audits were carried out regularly.

We spoke with the manager who said that the quality monitoring system enabled them to identify where changes were needed. They also highlighted positive feedback, from people who used the service, their relatives and the staff.

We spoke with three people who used the service and they were looking forward to the Christmas festivities. They made no specific comment about how the service monitored the quality of the care and support provided.