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

We identified a number of risks to people’s health and safety relation to the premises, water and fire safety, unsafe storage of equipment used in the delivery of care and infection prevention and control practices throughout the home. People, including those living with dementia, had access to unlocked store cupboards which placed them at risk of harm. The manager and staff were not alert to any safety risks that may affect people’s safety. However, people we spoke with told us they felt safe living at the home. They told us their needs were met and they received their medicines in line with their wishes and in a timely manner. There was learning from incidents and complaints but not enough oversight on the environment. Staff were recruited safely, trained and were supported in their role. Staff understood how and who to report concerns to internally and externally of the service but the safeguarding policy was not up to date.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives were confident the management were responsive to concerns and when accidents happened and learnt from mistakes or concerns.

The management team did not have enough oversight of the environment to understand the monitoring and improvements needed to learn from issues that had arisen. Staff and management used learning from complaints, incidents and safeguarding concerns to improve the quality of the service.

The provider did not have the systems to identify issues with safety of the environment; they had not had the opportunity to take the learning and make improvements. The manager used the learning from complaints, incidents and safeguarding concerns to improve the quality of the service.

People’s needs were assessed before they were admitted to the home to ensure the service could meet their needs. People were reassessed on return from hospital to ensure staff were aware of their changed needs.

Staff provided information to healthcare professionals to ensure they had the current information they needed to meet people’s needs.

The feedback from stakeholders was positive. GP and district nurses told us they believed all people received good clinical care. Both said they enjoyed coming to the service as people were well cared for and the manager was very organised.

The provider had systems in place to record all the relevant information about people’s needs required by other services such as hospitals, so they could provide continuation of their care.

People were protected from harm and abuse as staff understood how to recognise and report any concerns to the registered manager, provider and relevant professionals. People told us they were able to move around freely. A person told us, “My call bell keeps me safe whenever I call they are there in two minutes.” A relative told us, “We are happy with [Name], they are quite safe and secure.”

Staff had received training in how to recognise safeguarding concerns and report these to the manager.

People appeared comfortable in the company of staff.

The provider had systems to record and report safeguarding incidents and carry out investigations when asked to do so by the local safeguarding team. The safeguarding policy required updating.

People, and where appropriate their relative or representative, were involved in the assessments of their care and in making decision about their care and treatment. Relatives were confident risks were managed appropriately, for example equipment was used correctly to support people to be moved around the home safely. Relatives told us, “[Name is] very safe. [Name] tends to wander and staff always go with them” and “[Name] needs 2 to1 support it’s always provided, no issues using the hoist.”

Staff involved people in their assessments and reviews.

Staff involved people and their relatives in reviews of their care and ensured they understood feedback from health professionals such as the GP.

The provider had systems in place to involve people in their assessments, reviews and health planning.

People had access to the equipment they needed that promoted their safety. People’s comments included, “My own room is personalised to my own taste” and “Kenroyal has a large rear garden with lawns, flowers and plenty of seating.” A relative said, “[Name] room is spotless; they even deadhead the plant [in the bedroom].”

Staff told us the manager had provided a range of training in topics related to health and safety including the safe use of oxygen. Staff were given the policy and guidance on oxygen safety but this was not up to date. The manager was provided with the latest oxygen safety guidance but no action had been taken and the storage of oxygen cylinders in people’s rooms, oxygen compressors remained unsafe. The manager told us the maintenance person carried out repairs when required, but there was no oversight to ensure the problem was fixed or replaced, if required.

The manager told us regular audits were undertaken to address any risks in the environment. Whilst we saw evidence of these audits undertaken, they did not identify or address the concerns we saw during this assessment.

The management team and staff had not identified where equipment and furniture may cause harm to people. For example, there were combustible materials stored upstairs and loose wires in places with potential trip hazards. Free-standing bedroom wardrobes were not secured to the wall, which could put people at serious risk of injury if the wardrobe was to fall.

Some aspects of the environment increased the risk of harm to people. There were several unlocked doors leading directly to staircases and the boiler room. Poor lighting and uneven flooring in some areas increased the risk of people falling. Signage throughout was not consistently clear to enable people to navigate safely. Fire doors had been propped open, were not labelled, and there were visible gaps around door seals. The staircase door alarm did not activate when opened despite several attempts. Several bedroom doors indicated those people had difficulty in mobilising but the numbering system was not clear. This could delay a safe evacuation in the event of a fire. All these issues we identified were raised with management. Following the on-site assessment the provider told us wardrobes had been secured, and sent evidence of improved storage of oxygen equipment, cleaning products and numbering of bedrooms, however further action was still needed.

We observed staff using moving and handling equipment safely.

The management team and provider failed to have sufficient or effective systems to check and identify areas of risk in relation to the premises and equipment was in good repair, and installed correctly or to ensure substances that were harmful to health were locked away when not in use. These included fire safety, water safety and legionella, clinical waste management, and the unsafe storage of oxygen equipment and the substances that could be harmful to their health. Water temperatures we checked was a lot higher than what had been recorded, and could result on people being scalded. The manager was provided with the latest oxygen safety guidance but no action had been taken and the storage of oxygen cylinders in people’s rooms, oxygen compressors remained unsafe. The provider was asked address the serious issues immediately. Following a further onsite assessment, oxygen equipment was stored safely, and an external fire safety contractor had been contacted. We have told the provider to make improvements.

The management team and provider had a wide range of audits in relation to the safety of the environment. Whilst these were carried out regularly, they failed to identify and address risks within the environment. We saw the vast majority of audits were all marked positively with no actions undertaken in the days and weeks leading to our assessment, despite a significant number of environmental risks identified during our assessment.

People were cared for by staff that had the skills, knowledge and time to meet their needs. One person said, “[Staff] seem well trained; you ask them something and they know the answer.” Comments from relatives included, “I’m most impressed with the number of staff there” and “All the staff appear to be well trained and helpful.”

Staff told us there were enough staff to meet people’s needs and that staff were supported to carry out their roles.

There were enough staff to manage people’s needs and keep people safe from falls.

Staff had been recruited safely. However, the provider did not have a system to update staff disclosure and barring checks which are required to ensure staff remain of good character. The provider’s recruitment policy did not reflect current best practice.

People lived in a clean and hygienic environment that promoted their safety and wellbeing. People’s comments included, “It’s lovely and clean here” and “Staff always wear gloves and aprons, they do wash their hands in my bathroom every time.” A relative told us, “Kenroyal is very well presented with all rooms and walkways being clean and tidy.”

Staff were trained in infection prevention and control practice. We observed staff used PPE correctly to prevent the spread of contagious diseases, however, we did not observe staff washing their hands at regular intervals or using the sanitising gels because these dispensers were empty.The manager told us they carried out daily walk arounds however they had not identified the issues we found in relation to food debris, dirt, dust and stains found on furniture.

Premises and equipment were not clean or hygienic which increased the risk of cross infection. For example, there were cobwebs, dirt and old food debris such as spilt cereals and the shower heads were not cleaned. We saw brown staining accumulated on a chair within the ground floor lounge area. Food in the dining room fridge was out of date, which if consumed could result in people becoming unwell. Despite daily cleaning and equipment readily available dried food stains were evident. Hand sanitising dispensers were empty and no action had been taken to replenish these. Clinical wastes bin stored outside were unlocked, which meant anyone including members of the public could access the clinical waste. These issues were all raised with the manager. Some action was taken. Further action was needed and we have told the provider to make improvements.

Infection control audits and visual checks carried out by the manager were not effective to ensure people lived in an environment that was clean and hygienic. Where checks were completed we were not assured equipment was working effectively. For instance, fridge temperature fluctuated and it was not clear how staff are monitored the fridge temperatures to ensure food was stored was safe to consume. This was raised with the registered manager to address and some action was taken.

People received their medicines as prescribed. People told us they received their 'as required' medicines and these had helped to control their symptoms such as itching or pain.

Staff received the training and supervision they required to manage medicines safely. People received their medicines as prescribed, however, staff did not always record the times they gave ‘time-critical’ or ‘as required’ medicines. People who were prescribed ‘as required’ medicines received these regularly without any recorded explanation or review of the effect.

The provider did not have systems to ensure the practice of managing medicines matched the provider’s policies. The registered manager and nursing staff reviewed the management of medicines monthly; however, they had not identified their practice did not always follow the provider’s policies relating to the recording of the reasons for giving ‘as required’ medicines.