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Archived: The Elms @ Kimblesworth Requires improvement

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Reports


Inspection carried out on 28 March 2018

During a routine inspection

This inspection took place on 28 and 29 March 2018. We planned to undertake an unannounced focused inspection as a result of receiving information of concern about the running of the service. This inspection was carried out to check to see if the concerns were accurate, and also to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in August 2017 had been made. We intended to inspect the service against the key questions – is the service safe, is it effective and is it well–led. As continued concerns were found across the five key questions we changed the inspection to a comprehensive inspection.

At our last inspection in August 2017 we found breaches of regulations 11, 12, 13, 17, 18 and 19. The breaches related to the provider failing to meet the requirements of the Mental Capacity Act, ensuring people were cared for in a safe manner, staff were provided with the necessary support to carry out their roles and they had been appropriately vetted before they began working in the home. We also found the provider had failed to ensure there were sufficient and robust governance arrangements in place. The manager provided us with an action plan to show us what actions they were taking to continue with the improvements. At this inspection we found improvements had been made although we found there were continued breaches of Regulations 12, 17 and 18.

The Elms @ Kimblesworth is a ‘care home’. 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. At the time of the inspection there were 14 people living in the home.

At the time of our inspection a new manager who subsequently became the registered manager had begun to make improvements. They provided us with an action plan to show us what actions they were taking to continue those improvements. 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.

Security of the building needed to improve. Inspectors were able to access the building and people’s personal information undetected at 6.30am. The manager told us they would issue new guidance to staff which ensured greater security.

People were given their medicines in a safe manner. However we found improvements were required in the home to support people who had been prescribed topical medicines (creams applied to the skin).

During our last inspection we found a breach of Regulation 18 as staff had not received appropriate support through induction, training supervision and appraisal. At this inspection staff records showed there was a continued regulatory breach. Staff had not received supervision and training in topics relevant to their work.

Audits to measure the quality of the service failed to identify the deficits we found during our inspection and monitor the service across regulatory requirements. The service had yet to reach the stage where the outcomes of surveys, complaints and compliments drove improvements to the care provided to people.

Work had been carried out to make improvements to the cleanliness of the building and reduce the risks of cross infection. Further work was required to the home to complete this task.

The fire risk assessment had been updated and there were regular checks carried out on, for example, firefighting equipment and alarms. However we found a number of concerns about fire safety and asked the local fire safety officer to visit the home. The fire safety officer reported they had found a number of deficits and the area manager and the manager had agreed to address these.

At our last

Inspection carried out on 11 July 2017

During a routine inspection

This inspection took place on 11 and 17 July 2017. The first day of our inspection was unannounced. This meant the staff were not aware we would be inspecting on that date.

The Elms provides accommodation for up to 19 people who require nursing and personal care. There were 14 people using the service during our inspection.

There was no registered manager in post at the time of the inspection. The last registered manager had submitted their notice to the Commission to cancel their registration in November 2016. Two subsequent managers had been appointed but both managers had needed to tender their resignation. 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. A registered manager for one of the provider’s homes expressed their intention to add The Elms to their registration and during our inspection was acting as the manager. Following the inspection an application was received by CQC and the manager was registered for the service.

Since the last registered manager had left the staff had not received consistent management. As a result staff had resorted to trying to resolve difficulties themselves. A number of staff had contacted CQC to blow the whistle on their employer. This means they told CQC their worries about the home. Staff expressed concern that the fabric of the building was poor, people had been cold during a period when the boiler did not work, food bills had been cut and items not replaced or repaired when they had broken down. People confirmed to us they had not been able to have coffee. During our inspection we saw improvements were being made to the building and a jar of coffee was made available. The manager provided us with an action plan to refurbish the home.

We found the home to be lacking in cleanliness and the fabric of the building required improvement to allow cleaning to take place and prevent the spread of infections.

People’s medicines were safely administered. However, we found people who required medicines on an ‘as and when’ basis did not have plans in place to tell staff when people may need this type of medicine.

People’s personal risks had been identified by staff and actions put in place to mitigate the risks. Staff understood what these risks were and how to keep people safe. We found some risk assessments had not been updated since 2015 and we could not be reassured the risks were still pertinent. Other risk assessments including those appertaining to the building were in place and up to date.

We found there was not enough staff employed in the service. This meant staff were having to work long hours to cover shifts. We found new staff were being recruited and were awaiting a start date. One of these new staff members was an activities coordinator to support and encourage people’s participation in stimulating activities. People told us there was little to do in the home and they wanted some activities.

Audits had been carried out in the service. These include, kitchen audits, infection control and maintenance checks. We found these did not address the deficits we found in the home.

A staff member had been delegated to update people’s care plans. Where the plans had been updated we found they provided a good level of person-centred information and gave guidance to staff on how to meet people’s needs.

Staff knew people well who lived in the home. We found staff were caring and responsive to people’s needs. We saw they respected people and ensured their privacy and dignity was preserved. However we found staff wanted to be able to provide better care and create a more homely environment for people. They felt their care was compromised by the lack of investment in the home. Following the inspection the

Inspection carried out on 16 July 2015

During a routine inspection

This inspection took place on 16 July 2015 and was unannounced. This meant the provider did not know we were inspecting on that day.

This was the first inspection of the service under the new ownership of Jigsaw Care Limited

Kimblesworth is a home for up to 19 people who have mental health needs. It is located in a village outside of Durham with easy access to local amenities. At the time of our inspection 19 people were using the service.

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. At the time our inspection there was a manager in post who was not registered for the home. This manager had been registered for a sister home. CQC had received a notification to explain the changes in management. Following the inspection we spoke to the provider who thought the appropriate applications had been made and agreed to ensure appropriate documentation would be submitted.

We found the home was clean and tidy and there was a cleaning schedule in place to reduce the risk of cross infections. The provider had taken actions as recommended by the Infection Prevention and Control team to improve the building.

The provider had appropriate arrangements in place to safely administer people’s medicines.

We found staff had received appropriate and ongoing training to support them to care for people in the home. Staff had also received support through regular supervision and appraisals.

Work was on going to improve the fabric of the premises. At the time of our inspection a bathroom was being refurbished.

We found evidence of health checks carried out by the nurses in the home. The health checks included a person’s height, weight and blood pressure.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and the learning had been applied to people living in Kimblesworth.

All the care plans were in the process of an overarching review by the clinical lead to ensure consistency of care planning and best practice.

People’s needs had been assessed and people had in place a range of care plans. The care plans described people’s needs and people had also been involved in developing their care plans as we could see their preferences were included.

People had been engaged in a range of activities either on a one to one basis or as a part of a group activities.

The provider had in place an appropriate process to respond to anyone’s complaints.

We saw all records were kept secure, up to date and in good order, and maintained and used in accordance with the Data Protection Act.

Staff were complimentary about the manager and told us they felt well supported.

Fifteen out of seventeen people surveyed who were living in Kimblesworth said they would recommend the service to others.

The service worked in partnership with key organisations to support care provision, service development and joined-up care.