Archived: Koinonia Christian Care

Koinonia Christian Care is a 'care home'. The home accommodates up to 39 older people with dementia or age-related physical frailties across five adapted buildings. The service is a care home which supports people with Christian beliefs. At the time of the inspection there were 30 people living at the service.

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

Quality assurance processes were not routinely completed to ensure effective provider oversight of the running of the service. Analyses of incidents and accidents had not been carried out to establish risks, trends and patterns to allow continual learning to improve care.

People’s health risks were not always appropriately assessed, care plans were inconsistent and out of date to guide staff on how to meet people’s needs. This included providing safe support with swallowing difficulties, weight loss and catheter care.

People were not always supported by enough staff. Staff deployment meant some people with higher needs were not supported in a timely way. We saw where people required assistance at mealtimes, there were not enough staff in the unit to support them. The registered manager covered shortfalls on the rota. People told us they were aware of the shortages and told us staff were doing their best.

People were kept well informed of the changes within the service. A new provider was due to take over the running of the service. People and their relatives were able to ask questions in advance of this happening. One relative told us, “It's interesting to see what will happen with the new ownership. It's an independent caring family situation and I hope that doesn’t change.”

People were kept safe by staff who understood their responsibilities to recognise and report safeguarding concerns. People received their medicines in a person centred and timely way, staff were trained and assessed as competent before administering people’s medicines.

People spoke highly of the support they received. People told us they enjoyed the food and the staff were kind the them. Comments included, “The staff are excellent, I am glad I am here. I feel well cared for.” And, "It's a lovely place to be, I am happy, I have my friends, my health."

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

The last rating for this service was requires improvement (published 4 May 2020).

Why we inspected

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part by notification of a specific incident, following which a person died in hospital after a choking episode at the service. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risks and governance of the service. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Koinonia Christian Care on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to assessing and managing risks and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the new 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Koinonia Christian Care is a 'care home'. The home accommodates up to 39 older people

with dementia or physical frailty across five adapted buildings. At the time of the inspection there were 39

people living in the home.

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

People were not always treated with dignity at the home. Staff were polite and friendly but were sometimes task orientated. This meant staff focussed on a task rather than a person. The registered manager led by example and was helpful and chatty with people, but other staff did not always stop to talk or respond to people. People told us they found the staff to be caring. A person said, “Occasionally when they are busy [we feel rushed] but staff are always considerate.”

People’s care was personalised. However, it was not always recorded correctly, and some care plans were not up to date or had conflicting advice in them. People had assessments prior to living at the home, and care plans were created with input from people and their families. The registered manager understood the Accessible Information Standards and there was a selection of books in various formats for people to access. People were supported to develop friendships. The home had a strong Christian ethos, and this was a reason most people chose to live at the home. People told us there was plenty to do at the home. A person told us, “Yesterday we had a painting session. The lady brings in paints and we make something artistic, and another one is a chap with a ball, and we throw it into a thing on the table, it sounds silly but it makes you laugh. There’s a wonderful library here.”

While some care plans and risk assessments were complete, others were not up to date. This was an area that needed improvement to ensure staff knew how to care for and support people. The registered manager was working hard to improve the service and correct issues found at the last inspection, but this work was not completed. Staff told us they were happy at the home and felt well supported by the registered manager and the provider. People and staff spoke of the home as a family. People and their relatives were very happy with the registered manager and the management of the home. When asked what the home did well a relative told us, “How caring the staff are and how proactive the manager is. I feel listened to for example, if I make any requests for mum to have tea early the staff will ensure it happens.” A person told us, “Yes, the home runs beautifully without any hiccups.”

People were safe at the home. Well trained staff protected people from the risk of abuse. Peoples’ individual risked were assessed, and the registered manager ensured the home was safe. Plans were in place for use in the event of a fire or other emergency. There were enough staff to keep people safe and they were recruited safely. Medicines were administered by trained staff. The home was clean and smelled fresh. People were protected from the risk of infection. The registered manager audited and learned from any errors or near misses that happened at the home. A relative said, “I think that my mum is very safe living here. I see how the staff manage her and I think this place is absolutely wonderful. Mum has never had an accident since she has lived here and the staff are very aware of health and safety.”

People had effective care from staff at the home, who liaised with other healthcare professionals to ensure care was personalised. Staff used electronic devices and care plans to record and share information about people. The strong Christian ethos of the home ensured everyone was treated equally and with kindness. Staff had regular training including in specific subjects to assist with people’s specific needs, for example diabetes awareness. People told us the food served at the home was good. People ate in a communal area and were supported if necessary, by staff. The home was bright and clutter free. Signs helped people to orientate themselves as the home was quite large. Staff sought consent before providing care.

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 16 April 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the Caring Responsive and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Koinonia Christian Care on our website at www.cqc.org.uk.

What life is like for people using this service:

•The provider lacked effective governance systems to identify concerns in the service and drive the necessary improvement. At times, there was a lack of clear and accurate records regarding people’s medicines, support and any potential risks posed to them. Accidents and incidents were not analysed sufficiently to ensure risks were reduced for people.

•The provider had not followed legislation that required them to act in an open and transparent way when people came to harm.

•Best practice guidance was not utilised in providing an environment that promoted the well-being of people who lived with dementia and we have made a recommendation about this.

•Despite this, people were happy living at Koinonia Christian Care and people told us they felt safe. People were supported by staff who were kind, caring and who mostly understood their likes, dislikes and preferences. People were positive about the activities on offer and people’s religious needs were met. People were cared for by staff who were well supported and received regular supervision to meet people's needs effectively.

•People and their relatives knew the registered manager and felt able to speak to them if they had any concerns. The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support.

Rating at last inspection: Good (Report published 13 August 2016)

Why we inspected: This was a planned inspection based on our last rating. At the last inspection the provider was rated as Good.

Follow up: The service has been rated as Requires Improvement and three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We will request an action plan from the registered provider about how they plan to improve the rating to good. In addition, we will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Koinonia Christian Care is a care home without nursing that is registered to provide care and accommodation for 39 older adults. The home has a Christian ethos and people choose to live at Koinonia Christian Care for that reason. At the time of our visit there were 38 people living at the home. Some of the people in residence were living with dementia. The building consisted of five large Victorian terraced houses combined into one building. One of the houses was specifically designated for people living with dementia.

The service had a registered manager. 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.

We had previously carried out an inspection of Koinonia on 30 September and & 2 October 2015. At this inspection we found that the provider had met previous breaches of regulation and had met the warning notices issued, however we found additional breaches of regulations. At this most recent inspection we found that the provider had met these breaches of regulation.

Improvements had been made in recording information and ensuring that audits of practice had clear actions recorded and dates for completing these actions. We could see when actions had been completed and what was outstanding. Systems were in place to audit records so that if there were gaps these were identified and records were completed. The provider had a new electronic database for recording all information relating to people’s care which the registered manager told us had supported them and the team to organise and keep people’s records up to date. Risk assessments had been completed accurately to reflect risks that were current for people and therefore the appropriate actions needed to minimise these.

Improvements had been made in seeking and recording consent in line with the Mental Capacity Act (MCA). At this inspection we found that staff had received training in MCA and were knowledgeable about the principles of the legislation. People’s consent was being sought and where people had a lasting power of attorney in place a copy of this was in people’s care records. However some assessments regarding people who lacked capacity to make decisions in certain areas were still being completed so this remained an area of practice that needed to be sustained and embedded. We have therefore identified that this remains an area that needs improvement.

Staff were appropriately trained holding a Diploma in Health and Social Care and had received all essential training. Training was taking place on the day of our inspection. Staff told us they felt supported to carry out their roles and received and attended staff meetings. A new management structure was in place for carrying out regular and consistent supervision and this remained an area that needs improvement.

People were cared for by kind and compassionate staff. People told us how well the staff knew them. One person said “Staff are very kind and caring, willing to do anything to meet your every wish, desire or need, we really are spoilt”. People also told us they were treated with respect and dignity. One person said “I’ve never had to worry about my privacy or dignity the staff are very good”.

People could choose what they wanted to eat from a daily menu or request an alternative if wanted. People were asked for their views about the food and were involved in planning the menu. They were encouraged and supported to eat and drink enough to maintain a balanced diet. One person said “The food’s pretty good, I don’t have any complaints, and you’ve always got a choice. You can have extra drinks or anything outside of meal times.”

Care plans provided detailed information about people and were personalised to reflect how they wanted to be cared for. Daily records showed how people had been cared for and what assistance had been given with their personal care. There was a range of social activities on offer at the home, which people could participate in if they chose. There was a complaints policy in place and a procedure that ensured people’s complaints were acknowledged and investigated promptly. People and relatives were confident that if they had any concerns these would be responded to. One person said “It’s acted on If I say anything is wrong”.

The home was well-led by the registered manager and supported by a management team and the trustees. A positive culture was promoted which was centred on the religious ethos of the home. There was a range of audit tools and processes in place to monitor the care that was delivered, ensuring a high quality of care. These included regular reviews of care. People could be involved in developing the home if they wished through questionnaires and residents meetings.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

We found that some aspects of the service were not safe because people's assessments and care plans were not detailed enough to ensure their needs were met. Medication procedures were not followed and there was not a procedure in place for cleaning commodes. We have set compliance actions for the provider to tell us what they are going to do to improve these areas.

The manager was aware of the Deprivation of Liberty Safeguards and the implications of a recent court ruling. No-one was currently living at the service under the protection of the safeguards but the manager was in the process of making an application for two people who they felt would meet the criteria. This would ensure that any restrictions on a person's liberty was in their best interests.

There were procedures in place for the recruitment of new staff and these were followed. Appropriate checks were completed before new staff started working at the service.

Is the service effective?

The service is effective as people's needs are met. We spoke with nine people using the service who all spoke exceptionally highly of the manager, the staff and the service. All said they were receiving care and support which met their needs. One person told us, 'By and large, it is excellent, any problems get addressed'. Another person said, 'The staff are excellent, we all love them, nothing is too much trouble'. Other comments included, 'I am very happy to be here', 'It is lovely to be here' and, 'They are very good to us here'.

Is the service caring?

People felt the staff cared about them, and we saw the caring way in which staff and the manager interacted with people. One person told us, 'The staff have feelings for us', another said they had some problems the previous day and staff had been, 'good [with them] today, bless their hearts'. Throughout the day, we saw staff had a caring manner in the way they spoke with and supported people. As we walked around with the manager, they spoke with people about their individual needs, such as trying to source gluten free spaghetti.

Is the service responsive?

People felt involved with the service and had good relationships with the staff and manager. People told us the staff responded to their needs and requests. We saw some people's needs had changed considerably since moving into the service and the care they received had changed to meet their new support needs. However, their care plans had not been reviewed and updated to ensure they always received care which met their needs. We have set compliance actions for the provider to tell us what they are going to do to improve.

Is the service well-led?

People felt the service was well led and spoke very highly of the manager. One person told us, 'She [the manager] listens and acts. She has brought about a transformation'. Changes to the service had been made, both in response to non-compliance found during our last inspection and feedback from people using the service. However, there was not a formal system of quality assurance or auditing in place. We have set compliance actions for the provider to tell us what they are going to do to improve.

We spoke with five people who use this service, one relative and four members of staff. We found that people were happy living here and their care needs were met, especially with regard to their religious needs. One person told us "the food is good and I can have a cup of tea any time I like". Another person said "I can choose when to get up and I can have breakfast in my room". We saw staff treating people with dignity and respect at all times and one person told us "they're all very caring and willing to listen".

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People's care and welfare needs were recorded in detail and were being met in line with people's assessed needs. This meant that people experienced care, treatment and support that met their needs and protected their rights.

People told us that they felt secure in this service. This showed us that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff spoken with told us that they were up to date with their mandatory training and that they felt well supported by senior staff. Staff were able to outlined examples of the care and support that they provided for the people who were using this service. This meant that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We saw that the charity's trustees carried out monthly visits to monitor for themselves the quality of the services provided to the people using this service. We saw action plans that resulted from these visits. This showed us that the provider had an effective system to regularly assess and monitor the quality of service that people receive.