Kenroyal Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment we found the provider had made sufficient improvement and was no longer in breach of regulation.

The rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff understood their responsibility in relation to reporting all accidents and incidents. Learning from incidents was seen as a continual process to grow and deliver best care. A staff member told us, “We also reflect and learn. We do discuss incidents when things happen and what we need to do stop it happening again in the future as well. We are allowed to share our opinions and make sure we are consistent in how we do things.”

Accidents and incidents were recorded and reviewed by the registered manager and action was taken to prevent recurrence. Referrals were made if necessary to healthcare professionals or changes made to people’s care. Processes for investigating, analysing, and responding to accidents, incidents, complaints, and safeguarding alerts were in place.

People and relatives were confident to speak with a nurse in the first instance and were confident the registered manager would act on concerns. A relative told us, “I go in every day to see [Person name], no issues with safety.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There was an effective and safe admission process in place. This included people, their family and if required health professionals involved in the process to ensure there was continuity of care. The registered manager and nurses had good awareness of people’s needs and risks and the support they needed to promote their safety and wellbeing. They worked in partnership to ensure there was continuity of care when people moved between services. Feedback from health and social care professionals was consistently positive and included, “[Registered manager] attends the assessment and is highly skilled to offer the information required, their detail to knowledge is highly regarded by myself.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The provider shared concerns quickly and appropriately with the relevant authorities. The registered manager and nurses worked collaboratively with the safeguarding team and responded appropriately when safeguarding concerns were raised and took action to prevent recurrence.

Systems and processes were in place to protect people from abuse, report and monitor safeguarding concern and Mental Capacity Act (MCA) 2005, these were underpinned by policies and procedures. Staff were trained and understood their responsibilities to protect people from abuse. A staff member said, “It means protecting people from risk of abuse. I’ve never witnessed abuse here but if I did see any abuse, I would report it to the nurse or the manager.”

People and relatives told us they felt safe with the staff and the care provided. A person told us, “Staff are good to me; there's always someone around to help me, which makes me feel safe.”

A relative said, “I have never had to raise a concern, staff do manage any risks to keep my [Person name] safe.” Another relative said, “[Person name] was safe at Kenroyal because they are mostly supervised and staff understood [Person name’s] needs.”

The registered manager understood their responsibility under the MCA and Deprivation of Liberty Safeguards (DoLS). Records showed relatives, with the appropriate legal authority, had been involved in making best interest decisions for their family member. System in place enabled the registered manager to effectively monitor people with a DoLS, and the renewals.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them. Processes were in place to ensure risks to people were assessed, mitigated effectively, and monitored. For example, managing risk of falling and developing pressure sores. A relative described the assessment and care planning process, this involved a series of questions around risks, routines and preferences, and a care plan was put in place for them to approve.

People’s risk assessments were detailed and care plans provided clear instructions to enable staff to safely support the person and to reduce any risk of harm. There was information to enable staff to recognise how a person living with dementia expressed pain or discomfort. Also details of signs and symptoms to look for which indicates potential health risks such as high or low blood sugars and infections and the action staff should take. Assistive technology was used such as sensor mats to alert staff when people were moving independently. Risk assessments and care plans were reviewed and updated on a regular basis in accordance with the provider’s policy.

Staff were trained in areas to manage risk such as moving and handling, first aid and health and safety. For example, to maintain good skin condition and positional changes to prevent pressure sores. We observed staff using equipment correctly to move people safely. Personal evacuation plans were kept under review, to ensure staff had accurate information to support people safely in the event of an emergency.

People told us staff understood their needs safely. One person said, “I'm very comfortable and feel safe; like when they help me to shower and get ready; and they always listen to what I want.” Relatives we spoke complimentary about the care and support their family member received. A relative said, “We bought [Person Name] a special chair which could also be used as a bed and staff would use a lift aid to help [Person Name] get into bed. Staff were all trained to use equipment.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider and registered manager had made sufficient improvements to address the environmental risks we identified at the last assessment of the service. We found all bedroom doors had been labelled. All the fire doors were labelled and they all closed fully. There was improved lighting, and all wardrobes had been secured to the walls. There was improved signage, safe storage of oxygen equipment and all cleaning products had been stored in locked cabinets. The provider used an external fire safety officer and a health and safety officer for advice and support. The provider had taken action in relation to water safety and temperatures, and the fire risk assessment had been updated. People’s personal emergency evacuation plans had been reviewed and updated as needed, to ensure staff and the emergency services had sufficient instruction to support people to safely evacuate the building. The provider had strengthened the oversight system to ensure premises and equipment were safe.

People and relatives were complimentary about the environment, décor and the equipment provided to promote safety and independence. One person said, “It's a nice place. I love it here.” Relatives feedback was consistently positive. Their comments included, “It’s a very safe environment and staff looked after [Person name] very well. I’ve only got to say, can you do this, or can you get that, and it’s done,” and “It’s a very clean environment and it’s a nice, homely environment.”

The provider made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs.

People and relatives told us there were enough staff to meet their needs reliably. One person said, “There's too many staff around, everywhere you look; so, it's good if you need them.” Another person said, “I do speak in English, but I also like to speak in Gujarati with some staff.” Relatives also consistently had high praise for staff. Their comments included, “We think this place is perfect for [Person Name]; Manager knows [Person name] and us, and there's plenty of staff around; all are very good” and “On the whole staff are very willing and if they can’t help you, they’ll get a nurse.”

Staffing levels across the care home were consistently good, as evidenced by the staff rota, our observations during the inspection visit and feedback from people, relatives, staff, and professionals.

New staff and nurses were recruited safely. Staff completed induction and essential training related to people’s health, safety, and welfare. Staff competencies were assessed and checked periodically. Staff received training to meet people’s specific needs and had regular refresher training to ensure their knowledge and practice was in up to date with current best practice. Nurses were supported to maintain their professional skill, practice, and knowledge up to date. Staff were supervised and received feedback on their performance.

The provider had implemented periodic checks with the disclosure and barring service (DBS) to ensure staff remained safe and suitable to care for vulnerable people. This was underpinned with the updated policy and procedure.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider and registered manager had made sufficient improvements to address the issues related to infection prevention issues we identified at the last assessment of the service. All areas of the care home used by people was visibly clean. Staff were trained and policies and procedures were in place to support effective infection control and prevention. We observed staff washing their hands regularly and using personal protective equipment (PPE) correctly when carrying out care tasks. This helped to protect people from the risk of cross infection. Housekeeping staff followed daily cleaning schedules, and dining rooms were clean after each dining service. The clinical waste bins stored outside were always locked, and clinical waste collection arrangements were in place. Food stored in fridges and freezers were within the manufacturer recommended temperature range and checked daily. Food stored in the fridge was dated when opened to ensure it was safe to consume. The provider had strengthened the monitoring systems with regularly audits and checks completed to ensure premises and equipment were safe.

People and relatives spoke positively about the hygiene and cleanliness. A person said, “it's quite clean. I prefer to wear an apron just in case I spill food on my clothes.” Relatives’ comments were also consistently positive and included “Staff washed hands and wore gloves and aprons” and “The environment was kept and clean and hygienic and there aren’t any nasty smells and [Person name’s] bedroom and bathroom was kept clean and tidy.”

Processes were in place to ensure staff, people using the service and their relatives were informed of concerns relating to infectious outbreaks.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff involved people in planning, including when changes happened.

People told us they received their medicines at the right time. Relatives expressed no concerns in relation to how their family members medicines were managed. Their comments included, “[Person name] doesn’t like taking medication and it was important for them to have it on time. Staff are very good at talking to them to persuade them into taking it and making sure they have swallowed it.” Another relative said, “Staff administer [Person name’s] medication and they would tell the family straight away if they had an infection and had been prescribed antibiotics.”

Safe medicines administration and recording system was in place. Medicines were stored securely. This included storage of controlled drugs, which requires more control due to their potential for abuse had restricted access to authorised staff. Medicines with a limited shelf-life such as liquids and creams were dated appropriately.

The registered manager had made sufficient improvements to address the medicine related issues we identified at the last assessment of the service. There was clear recording where variable doses and time sensitive medicines, such as Parkinsons medicines, was prescribed and administered correctly. People’s care plans and protocols for ‘as required’ medicines were person-centred and contained sufficient information for staff to support people with their complex needs. Where people received their medicines via transdermal patches applied directly to the skin, staff had documented the date and the application site, checks carried out and the date of removal. However, there was no body chart to show the exact application site to reduce the risk of skin sensitivity and irritation. The registered manager collaborated with nurses and took immediate action and implemented body charts to document accurately the application site with no impact on people’s health. This was communicated with all nurses and staff, to ensure they document checks completed when supporting the person with personal care.

Medicine audits and checks were regularly completed and where shortfalls had been identified, actions had been taken to make improvements. The provider further assured us that action would be taken to strengthen the oversight of medicines management.