Kenroyal Nursing Home

Kenroyal Nursing Home is a residential care home that can provide long and short-term residential and nursing care for up to 64 older people, including people living with dementia. At the time of our inspection 61 people were using the service.

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

Improvements had been made to the risk management systems in place to ensure people were cared for and supported safely. Environmental checks had been improved so that the service was a safe place to live and work.

Improvements had been made to the medication practices and procedures to make sure people received their medicines as prescribed. Medicines were administered by trained staff and were stored safely.

Infection control processes had been improved to protect people from the spread of infections. Information regarding infections was in place and procedures relating to infection control were consistently followed.

The systems in place to ensure lessons were learnt when things went wrong had been improved. The registered manager had implemented a system to monitor incidents and accidents monthly so action could be taken to promote people’s safety.

The service had improved their governance systems to ensure all aspects of the service and people’s care were continuously assessed and monitored. A range of audits were in place to monitor the quality and safety of service provision.

People we spoke with felt safe living at Kenroyal Nursing Home. There were systems and processes in place to safeguard people from potential harm. Staff completed training about safeguarding people from harm and knew how to report abuse.

There were sufficient numbers of staff to meet people's needs safely. People were supported by regular staff who knew them and their needs well, which promoted continuity of care. The provider had followed their recruitment practices to ensure people employed were suitable to work at the service.

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 2 October 2020) and there were two breaches of regulation.

Why we inspected

We carried out an unannounced focused inspection of this service on 18 August 2020. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment and Good Governance.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to Good. This is based on the findings at this inspection.

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.

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

Follow up

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

Kenroyal Nursing Home is a residential care home that can provide long and short-term residential nursing care for up to 64 older people, including people living with dementia. At the time of inspection 55 people were using the service.

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

Risks to people had not always been identified and detailed strategies had not been put into place to mitigate those risks. This put people at risk of harm.

The environment was not always safe. During the site visit, we found unlocked doors, access to hazards products and fire safety concerns.

Medicine management required improvement. Medicines were not always given as prescribed and documentation relating to medicines was not always completed.

Infection control processes did not always protect people. Information regarding infections was not always in place and procedures relating to infection control were not consistently followed. However, the home appeared clean.

The systems and process in place to ensure oversight of the service were not always effective in identifying concerns and addressing areas of concern.

We made a recommendation regarding the investigation and reporting of bruising and incidents.

People were supported by kind, caring staff who had been recruited safely and had received the appropriate training to meet people’s needs.

Staff were supported well by the registered manager and provider and felt safe at work.

The registered manager and provider put an action plan into place immediately after the site visit to identify the plans in place to rectify the concerns found.

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 good (published 17 July 2018)

Why we inspected

The inspection was prompted in part due to concerns received about unexplained bruising, record keeping, and repositioning tasks being completed. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 Kenroyal Nursing home 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.

We have identified breaches in relation to risks to people and oversight of the service at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kenroyal Nursing Home 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.

Kenroyal Nursing Home is located in Wellingborough town centre and provides care for up to 64 older people who may also be living with dementia. At the time of the inspection 64 people were using the service.

At the last inspection in May 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of good This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Prior to this inspection we received information of concern that prompted us to fully review how people were safeguarded from the risks of abuse. The registered manager and staff had a good understanding of what constituted as abuse and the safeguarding procedures to be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Appropriate staffing levels ensured people’s needs were met in a timely manner.

Staff induction training and on-going training was provided to ensure staff had the skills, knowledge and support needed to perform their roles and ensure people’s needs were met. Staff were well supported by the registered manager and senior team; all staff had regular one to one supervisions.

People's consent was gained before any care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. The care plans reflected people’s likes and dislikes, and staff supported people to make decisions about their care and treatment.

People were involved in their own care planning and could contribute to the way in which they were supported. People and their family were involved in reviewing their care and making any necessary changes.

Systems were in place for people to raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through reflective practice and positive communication.

Quality monitoring systems were in place to continuously learn and improve the service. Routinely audits were carried out on all aspects of the service and areas identified for further improvement had appropriate action taken.

There was a registered manager in post. 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.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report concerns to the relevant authorities. Staff knew their safeguarding responsibilities and how to report any safeguarding concerns they may have.

Sufficient numbers of experienced staff were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from staff unsuited to the role.

The registered manager and staff knew their responsibilities as defined under the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately.

People received sufficient support to eat and drink and maintain a healthy balanced diet. Staff monitored people’s health and well-being and ensured they had access to healthcare professionals when required.

People’s care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. People and their representatives had been involved in planning and reviewing their care.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs. People experienced caring relationships with the staff that provided good interaction by taking the time to listen and understand what people needed.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensure the care provided was tailored to meet their individual needs.

People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was routinely monitored by the registered manager and overseen by the provider.

This is a summary of what we found-

Is the service safe?

People were cared for in an environment that was hygienic, clean and well maintained. We found sufficient hand washing facilities available for both people and staff to use within the home and saw that staff had access to good supplies of protective equipment, including gloves and aprons.

People had care plans in place which identified their needs and we observed that staff followed these. The people we spoke with stated that staff had a good awareness of their needs.

The equipment needed to deliver people's care was available for staff to safely meet their needs. We found that this was well maintained and staff told us that the provider was proactive in ensuring that good supplies of hoists, slings and profiling beds were accessible for use.

There were sufficient numbers of care staff on duty to meet the needs of people and people told us that their requests for assistance were always met promptly. Staff had received training to ensure they had the necessary qualifications and skills to safely meet people's needs.

Is the service effective?

We observed that staff were knowledgeable about people's needs and how their care was delivered. Most people told us that they were happy with their care. A relative told us, "The staff are all so kind, we always get offered a drink when we arrive and staff are always friendly to us.' Another relative said, 'We have no complaints at all, the care is really very good. If we ask for something to be done then it is.'

Is the service caring?

We observed that staff approached people respectfully and were caring in their approach, giving people time to communicate their needs. We saw some good examples of positive care and engagement with people from staff, with them using gentle voices and touch as a method of reassurance for some people. This method of communication was conducive to a relaxed atmosphere within the home and we observed that staff remained calm even though busy. One person told us, "I am happy here." Another person said, "Yes, it is good."

People were assisted to move around the home as they needed and the care we observed was not rushed, and took people's abilities in to account. We found that people were offered two choices of food for their main meal of the day and this was prepared to their liking. Where people needed assistance to eat their meal, this was provided on a one to one basis and the mealtime was relaxed and supportive.

Is the service responsive to people's needs?

We saw that care plans had been updated when people's needs had changed and that referrals had been made to health and social care professionals when needed. We looked at care records and found they reflected the care we observed being given. One relative said, "We were asked if we wanted to keep our own GP or have the GP that attended the care home, we chose to have the one who regularly visited." Another relative told us, "If my mother is ill I know she will be safe with how the home deals with things."

Where people needed additional support or equipment then liaison with healthcare professionals took place for the necessary equipment to be obtained. People received their medication from staff who had received appropriate training and who understood their needs. Where new medications had been prescribed, these had been obtained in a timely way so people's changing healthcare needs were managed to promote their welfare.

Is the service well-led?

The provider had appointed a manager who was registered with the Care Quality Commission to manage the service on a day to day basis. We found that the manager was supported by an effective structure of staff with support from the provider on a regular basis.

Quality assurance processes were in place and we saw these were completed on a regular basis and to identify shortfalls if and when these occurred.

A person who used the service who we spoke with said "The carers are really good, nothing is too much trouble for them."

We also saw a chiropodist who was providing a service to some of the people who used the service. This person said " I am always greeted warmly by staff, they are always helpful, always busy it is a pleasure to visit."

We found that Kenroyal Nursing Home was compliant with the regulations we examined against.