Archived: Kimberley Nursing Home

Updated 11 June 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 and 11 February 2015 and was unannounced. It was carried out by two inspectors and a specialist advisor who was a qualified nurse. Before the inspection, we reviewed information we had about the service such as notifications the service were required to send to the Care Quality Commission (CQC).

During this inspection we spoke with nine people living at the home, three relatives, two nurses, four care staff, two visiting nursing professionals, the registered manager and the nominated person. We also spoke with the senior nurse from the local nursing impact team before the inspection. We observed care and support in communal areas. To do this we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We looked at the care records for eight people and the care three of these people received more closely. We reviewed the medicines records for all the people living at the home, the training and staff supervision records for all staff employed at the home and looked at seven staff files. We also looked at other records that related to how the home was managed including the quality assurance audits.

Updated 11 June 2015

This unannounced inspection took place on 10 and 11 February 2015. Kimberley Nursing Home provides accommodation and nursing care for up to 38 older people. There were 18 people living at the home when we visited. The home was based on three floors. There were bedrooms and bathrooms on each floor. Although 10 of the rooms were designated for double occupancy, on the day of our visit each person had their own room.

Although the care home has been in existence for many years it has been re-registered on 16 December 2014 to the current provider, Kimberley Home Ltd.

Staff, people and relatives did not fully understand the new registration of Kimberley Nursing Home and were not aware how the changes may affect them. When we spoke with people and relatives, they appeared unclear about who the manager of the home was and staff referred to the nominated person and the administrator as the owners of the home. A nominated individual is employed as a director, manager or secretary of the organisation with responsibility for supervising the management of the regulated activity. The administrator explained to us the policies and procedures for the new limited company were not in place during this inspection and staff had not yet been given new contracts. The lack of up to date information and processes meant that staff, people and relatives had not been kept informed of changes within the service.

The home had a registered manager at the time of the inspection. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not always ensure that the premises were safe. The communal bathrooms were congested with equipment, including hoists, walking frames, laundry bins and wheelchairs. Emergency pull cords in the bathrooms and toilets were not all within reach, some of the cords had been tied up. This meant that where they were able to, people could not use the bathrooms independently or safely.

We saw several radiator covers had broken fret work with jagged edges and were not securely attached to the walls. One of the handrails on the stairs were loose We saw occupied bedrooms, which contained broken furniture, a broken chest of drawers and bedframe. Two unlocked rooms housed numerous items stored up to ceiling height. People were therefore not always protected against the risks associated with a lack of maintenance of the premises and adequate risk assessments.

The provider did not carry out adequate health and safety risk assessments in relation to the premises. Regular checks of maintenance and service records were not conducted. We saw that the doors to the sluice rooms were open and inside were bottles that contained cleaning fluids. This meant that the risks of people accessing these areas had not been mitigated by keeping doors locked and ensuring people were protected against faulty equipment or inadequate maintenance.

A gas safety inspection was conducted with recommendations for gas safety work to be carried out. We did not see any evidence that the works needed had been scheduled.

There were individual risks assessments in place to ensure the safety of people using the service; however these had not always been updated as required to reflect people’s changing needs. We saw that daily records were not kept confidentially. There was a book of accident and incident forms completed correctly however no summary or analysis of the records had been undertaken although the majority of the incidents related to two people.

We observed there were enough staff on duty to attend to people’s needs. The home did not employ an activities coordinator and the registered manager told us that a member of staff was allocated each day to engage people in activities: we did not see this effectively managed. An activities company came to the home for two hours twice a week and the quiz we observed appeared to be enjoyed by people.

Staff recruitment procedures were not sufficient to ensure that people were kept safe. Not all the files we looked at had a current criminal records check and none of the files contained a health declaration. We saw that two overseas staff had outstayed their ‘leave to stay’ permit.

We found that not all medicines were stored safely. The medicines fridge had recorded temperatures of between 10.1 and 18.4 degrees Celsius, recommended temperatures should be between two and eight degrees centigrade. Unused or old medicines were not stored securely.

We saw the kitchen was clean, ordered and clear of clutter and daily hygiene checks were all up to date. The laundry room housed suitable cleaning equipment. Soiled linen was put into separate coloured bags and washed separately. But the provider did not ensure that all parts of the premises were cleaned to an adequate standard. We saw the décor of the whole house was poor, which made it difficult to maintain good hygiene standards. Some bathrooms and toilet facilities were unclean and had broken tiles and lime scale on pipework. Some of the chairs and carpets throughout the home were stained and dirty. This lack of cleanliness did not help to ensure people were protected from the risks of the spread of infection.

Records showed there was an annual training programme in place, but more than half of staff had not received yearly updated training. Staff we spoke with confirmed they had received an induction, but did not always receive regular one to one supervision. The lack of training and consistent supervision meant that staff were not as well supported as they could be.

We found the provider had not always taken the correct actions to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were met. These safeguards ensure a service only deprives someone of their liberty in a safe and correct way, when it was in their best interests and there was no other way to look after them.

People’s nutritional needs were assessed and a record of this was kept in the care plans we reviewed. We saw records of weight monitoring in care plans but records were not consistent or clear. Food preferences and dietary requirements such as soft food and food allergies were recorded but not shared effectively with kitchen staff. The menu we looked at appeared balanced and nutritious, although it did not reflect what was served on the two days of our inspection. We observed during the lunchtime on the first day that most interactions between staff and people were positive. However people were not encouraged to eat more when they had only eaten a small amount, their plate and the remaining food was taken away. The issues we identified meant that there were risks that people’s nutritional needs were not being met.

Records showed that people received visits from health care professionals such as the GP, chiropodists, the tissue viability nurse or other specialist nurses. These visits by specialist professionals helped to keep people well.

People were not always looked after by staff who were caring. Relatives we spoke with were fairly complimentary about the home, but people using the services were less complimentary. During our inspection we heard two call bells that went unanswered for 15 minutes, and found another person sitting in a cold room with the outside door open, which they were unable to close. This lack of attention by staff meant that people’s needs were not attended to in a timely manner.

None of the people who used the service could recall seeing their care plan or giving agreement to their care and treatment and none could recall taking part in any review of their care. This meant that people were not involved in the care planning to meet their specific needs.

We observed that bedroom and bathroom doors were closed when delivering personal care and that most staff knocked on bedroom doors before entering, but we observed a few instances where people’s privacy and dignity were not being appropriately promoted. For example screens used in communal areas were insufficient to protect people’s privacy. Staff did not engage with people while delivering personal care and people’s clothes were marked with the person’s room number and not their name.

People’s files were not ordered in a consistent fashion and were difficult to navigate and were often lacking in detail. The care plans we looked at were not always detailed enough to describe how to meet a person’s individual needs, their background, life style, wishes and preferences of how they would like to be cared for.

The provider had some quality assurance systems in place but people were not always protected against the risks of poor care and treatment because these systems were not always effective in identifying areas for improvement and for ensuring that prompt remedial action was taken to make improvements.

From our discussions with the registered manager, it was clear they had some understanding of their management role and responsibilities, but they had not always notified CQC of incidents as required by law. The provider had not sent a notification when the lift was out of order for three days.

People, relatives and staff were asked for their opinion of the service through an annual survey; the last was conducted in April 2014 under the previous registration. A new survey was being conducted at the time of the inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find the action we have asked the provider to take at the back of this report.