About the service Kenton Manor is a residential care home providing personal and nursing care to 64 people at the time of inspection, some of whom were living with a dementia. The service can support up to 65 people in one large adapted building.
People’s experience of using this service and what we found
People were at risk of harm due to medicines not being managed safely and clinical staff did not follow best practice guidelines. Prescribing instructions for medicines were not always followed correctly by staff.
Risk assessments and care plans were missing from people’s care records. Care records and risk assessments that were in place were not always legible and therefore could not be followed safely by staff. Care plans were not personalised and did not reflect people’s individual choices or needs.
The service was not well-led and there continued to be a lack of oversight by the provider and registered manager. The quality and assurance systems in place at the service were not effective. Issues identified were not always acted upon to remove or mitigate risks. Actions we asked the provider to complete after our last inspection had not been fully completed.
Staff did not always demonstrate knowledge or competence when delivering support to people. Best practice guidance was not always followed, and staff did not follow processes created by the registered manager or provider.
Since our last inspection the registered manager had worked with care staff to improve the culture and care provided to people, but this positive staff culture was not always demonstrated by clinical staff. Staff did not follow infection control procedures and associated risks had not been identified or mitigated.
People told us that they felt safe and happy living at the home, and relatives agreed with these comments. People were engaged in a range of meaningful activities and had access to the local community. The service encouraged people’s social relationships and welcomed all visitors into the home.
People were provided with a range of food and drinks to help them to maintain a healthy balanced diet. People were happy with the food and the selection available. People were regularly asked for their feedback about the service and care provided.
Staff received regular training and supervisions. Staff, people and relatives were complementary about the registered manager. Staff had access to regular team and handover meetings. Care staff were very kind and caring with people, and respected their privacy and dignity.
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 7 November 2018) and there were multiple breaches of the regulations. At this inspection we found the provider and registered manager had not made improvements to the safety and quality of care provided to people or to the leadership and governance of the service. Improvement had been made with regards to staffing levels within the service, but we found clinical staff were not always fully competent to keep people safe.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected:
This was a planned inspection based on the previous rating.
Enforcement:
The service met the characteristics of inadequate in three key questions of safe, effective and well-led. The service has been rated as requires improvement in caring and responsive. We have identified breaches in relation to medicines management, infection control, staffing knowledge and competency, providing person centred care and the effectiveness of the leadership and governance of the service.
We have requested that the provider reviews all care records, including 'as required' medicine protocols, to ensure that they are fully completed, accurate, and legible.
Please see the action we have told the provider to take at the end of this report. 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.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety and seek assurances of the progress of improvements. We will work with the provider, local authority and Clinical Commissioning Group (CCG) to monitor progress and discuss on-going concerns. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.