Archived: Keats House

Keats House is a residential care home providing personal and nursing care to up to seven people with mental health needs. There were seven people using the service at the time of our inspection

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

There were systems in place to protect people from the risk of infection and staff had received appropriate training in this. Overall, the service was clean and hazard-free. However, as identified in our previous inspection, there were areas of the kitchen which still required deep cleaning and repair.

Risks to people’s safety and wellbeing were appropriately assessed and mitigated, however risk assessments lacked clarity when describing actions taken to reduce risk. People had COVID-19 risk assessments in place but these did not identify people’s individual characteristics.

There were systems in place to monitor the quality of the service and these were mostly effective. Although the provider had made improvements, we found some concerns identified at our last inspection were repeated at this inspection. For example, monitoring checks had failed to identify and address the kitchen cleanliness and repair issues we found.

People’s healthcare and nutritional needs were met. People were supported to access healthcare professionals and to attend appointments as needed.

Medicines were managed safely and people who used the service received these as prescribed.

The provider sought feedback from people. People and staff were confident they could raise any concerns they had with the registered manager and felt they would be listened to. We received positive feedback from people who used the service. People said staff were caring and treated them with dignity and respect.

There were enough staff to support people and meet their needs. Staff were recruited appropriately, and all checks were in place. Staff received an induction, training and supervision and felt supported in their roles.

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.

The registered manager and senior staff were responsive to and worked in partnership with other agencies to meet people’s needs.

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 5 November 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Enforcement and Recommendations

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 safe care and treatment and well-led 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 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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Keats House is a residential care home providing personal and nursing care for up to seven people with mental health needs. There were five people using the service at the time of our inspection.

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

There were systems in place to protect people from the risk of infection and staff had received appropriate training in this. Overall the home was clean, hygienic and hazard-free. However, there were areas of the kitchen which required deep cleaning and repair. The provider took immediate action to make improvements in this area.

Risks to people’s safety and wellbeing were appropriately assessed and mitigated, however risk assessments did not include risk levels and this meant staff may not identify areas which are high risk.

People received their medicines safely and as prescribed although we found a recording error which may have impacted on the person receiving this medicine as prescribed.

There were enough staff to meet the needs of people who used the service. The provider had robust procedures for recruiting and inducting staff to help ensure only suitable staff were employed. There were regular health and safety checks to help ensure the environment was safe.

The provider had systems for monitoring the quality of the service and these had mostly been effective and had contributed in the improvements we saw during our inspection. They liaised with the local authority and external professionals to ensure people who used the service were supported with their individual needs.

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 24 January 2020) and there were multiples breaches of regulations. We issued the provider Warning Notices for Regulations 12 and 17. 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 had met the requirements of the Warning Notices. However, we found some areas which required further improvement.

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. During the visit, we made the decision to widen the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Keats House is a residential care home providing personal and nursing care to up to seven people with mental health needs. There were six people using the service at the time of our inspection, one of whom was in hospital.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Where there were risks to people’s safety and wellbeing, these were assessed. However, where a person had lost a significant amount of weight, there was a lack of monitoring and prompt action had not been taken to mitigate the risk and meet the person’s needs.

Although in general, people’s healthcare needs were met, in relation to the person who had lost weight, this was not the case as no action had been taken when a recent further weight loss had been identified.

Medicines were not always managed safely. The provider’s medicines audits had failed to identify a discrepancy in the number of a person’s tablets. Audits had also identified medicines were stored at a temperature exceeding safe levels, but no action had been taken to address this.

There were systems in place to monitor the quality of the service but these had not been effective and had not identified the issues we found during our inspection. Although the provider told us they learnt from mistakes and made improvements when things went wrong, we found some concerns identified at our last inspection were repeated at this inspection. For example, no action had been taken when a person had continued to lose weight, and no action had been taken when the temperature of the medicines cupboard exceeded safe levels.

The provider sought feedback from people, but this was not always regular, and people had not been consulted this year. People and staff were confident they could raise any concerns they had with the registered manager and felt they would be listened to. We received positive feedback from people who used the service. People said staff were caring and treated them with dignity and respect.

There were enough staff to support people and meet their needs. Staff were recruited appropriately, and all checks were in place. Staff received an induction, training and supervision and felt supported in their roles.

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.

The registered manager and senior staff were responsive to and worked in partnership with other agencies to meet people’s needs.

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 31 January 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 enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

Enforcement

We have identified breaches in relation to safe care and treatment, person-centred care and good governance at this inspection.

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 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.

At this inspection we have rated the service requires improvement in the key questions of ‘is the service safe?’, ‘is the service effective?’, ‘is the service responsive?’ and ‘is the service well-led?’ The overall rating for the service is requires improvement.

Keats House is a 'care home' without nursing. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care for up to seven people with mental health needs. There were seven people using the service at the time of our inspection.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

During the inspection we found there were risk assessments in place but these did not identify all risks, and where risks were identified the risk management plans did not always include guidelines about how to mitigate these.

There were no person-centred care plans in place, so people’s individual needs and wishes about how they wanted their care delivered were not recorded, so staff were clear about how to meet people’s needs.

Until September 2018, people’s records were reviewed and updated monthly. However, there had been no reviews in the last three months. Most records were not signed by people who used the service although the registered manager told us people were able to.

People's health and nutritional needs had been assessed before they moved into the home. People had access to healthcare professionals to support them. However, staff had failed to take action and refer two people who used the service when they had lost a significant amount of weight and were at an increased risk of malnutrition.

There was no evidence that people were engaged in activities, consulted about what activities they wanted to do. There were no individual activity plans in place and some people reported they were lonely and had nothing to do.

The provider told us they had systems in place to monitor the quality of the service and put action plans in place where concerns were identified. However, these were not recorded and had failed to identify the issues we found at this inspection so the necessary improvements could be made.

Recruitment checks were carried out before staff started working for the service and included checks to ensure staff had the relevant previous experience and qualifications.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person-centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We also found that the environment was not always tailored to the individual needs of people and areas of the home needed updating and decorating. We have made a recommendation about this.

People were protected by the provider’s arrangements in relation to the prevention and control of infection. Communal areas were clean. However, some bedrooms were not always clean thoroughly.

The provider had a policy about end of life care. However, staff had not received training in this subject and none of the people who used the service had an end of life needs assessment or care plans. The provider acknowledged that this area needed to be developed further to ensure they could meet people’s needs when they reached the end of their lives.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA). People had their capacity assessed before they moved into the home. All people had the mental capacity to make decisions and no one was being deprived of their liberty.

Staff followed the procedures to manage medicines and people received their medicines safely and as prescribed.

The provider had processes for the recording and investigation of incidents and accidents. The manager told us there had not been any incidents or accidents in the last year.

People were supported by staff who were sufficiently trained, supervised and appraised. The registered manager liaised with other services to share ideas and good practice.

Keats House provides residential care for up to seven adults with mental health needs. There were six people living at the service at the time of our inspection.

There was a registered manager in post at the service at the time of our inspection. 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.

People told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm. There were sufficient staff on duty to meet people's needs and the provider had contingency plans in place in the event of staff shortage to ensure people's safety.

Staff had undertaken training on the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). They ensured people were given choices and opportunities to make their own decisions.

There were arrangements in place for the management of people's medicines and staff had received training in administration of medicines.

People's nutritional needs were met, and people chose what they wanted to eat and drink.

Staff received effective training, supervision and appraisal. The registered manager sought guidance and support from other healthcare professionals and attended workshops and conferences in order to cascade important information to staff, thus ensuring that the staff team were well informed and trained to deliver effective support to people.

Staff were caring and treated people with dignity and respect. Care plans were clear and comprehensive and written in a way to address each person's individual needs, including what was important to them, and how they wanted their care to be provided.

A range of activities was provided both in the home and in the community. We saw that people were cared for in a way that took account of their diversity, values and human rights.

People, staff, relatives and healthcare professionals told us that the management team were approachable and supportive. There was a clear management structure, and they encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service to ensure that areas for improvement were identified and addressed.

At this inspection we looked at the steps the provider had taken to ensure the premises was being adequately maintained. We found that improvements had been made. This meant that people benefited from a safe and well maintained home.

People had their needs assessed and care was planned with the support they required documented in their care plan. Risk assessments had been completed and a record of risk management was contained in their records. Arrangements were in place for the safe management of people's medication. There were enough staff on duty to meet people's needs and staff were suitably qualified and skilled.

The provider had not ensured that the environment was maintained to a standard that would promote people's health and wellbeing. Parts of the home were not maintained adequately and in need or cleaning, repair or replacement. The provider has not met the required standard for safety and suitability of the premises.