We carried out a review of the data available to us about Kiwi House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Kiwi House, you can give feedback on this service.
People’s experience of using this service and what we found
Risks were assessed and mitigated and reviewed regularly. People were kept safe from avoidable harm and medicines were managed safely.
There were enough suitably trained staff to meet the needs of those living at the service.
People’s independence was promoted where possible. 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.
Management oversight had continued to improve; The service had a care manager who understood the service and they had recruited a new manager who would be registering with the Care Quality Commission.
The provider was open and honest and acknowledged improvements were ongoing.
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 October 2021)
Why we inspected
We undertook this focused inspection to check they 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.
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 overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kiwi House on our website at www.cqc.org.uk.
At our last inspection there were two continued breaches in Regulations 12 (Safe Care and Treatment) and 17 (Good Governance). . At this inspection we found enough improvement had been made and they were no longer in breach of Regulations.
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.
People’s experience of using this service and what we found
Risk were not always assessed and mitigated. People were not always kept safe from avoidable harm and medicines were not always managed safely.
There were enough suitably trained staff to meet the needs of those living at the service.
Management oversight had improved; however, it was too recent to see effective change and improvement in all areas.
The provider was open and honest and acknowledged further improvement was needed.
There was a new manager who was making a positive impact on the service.
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 Inadequate (Published 28 June 2021)
Why we inspected
We undertook this focused inspection to check they 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.
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 report.
You can see what action we have asked the provider to take at the end of this report.
The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kiwi House 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 we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
There are two continued breaches in Regulations 12 (Safe Care and Treatment) and 17 (Good Governance). At our last inspection there was also a breach of Regulation 18 (Staffing) and Regulation 13 (Safeguarding). At this inspection we found enough improvement had been made and they were no longer in breach of Regulation 13 or 18.
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 ongoing 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.
During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Kiwi House is a residential care home providing personal and nursing care to 78 younger and older people, some who may be living with dementia. There were 63 older people living at Kiwi House at the time of the inspection. The care home accommodates people across three separate floors, each of which has separated adapted facilities.
People’s experience of using this service and what we found
Systems did not always safeguard people from abuse. People were not always protected from avoidable harm and lessons were not always learnt when things went wrong. Medicines were not always managed in line with good practice. Sufficient staff were not always deployed to ensure people’s safety and staff training had not always led to competence. Procedures were in place to ensure risks from infection were reduced.
Policies and procedures were in place to help ensure the quality and safety of services however, these had not always been followed. Audits had not always identified shortfalls and led to improvements in the quality and safety of services. Records were not always accurate and up to date. Opportunities for continuous learning and improvement had been missed. Working in partnership with others had not always been effective.
Staffs’ knowledge and understanding on training and people’s healthcare needs was not regularly checked in supervision; some staff felt they lacked knowledge in areas of people’s healthcare needs. Referrals to other healthcare services had not always been made effectively. People’s care needs were assessed.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Care plans were personalised however, it was not clear how people were involved in reviewing these. People’s independence was promoted, and people felt respected by staff. People liked the staff team and felt they were kind.
Not all people had their preferences met and care plans did not show how they had been reviewed with people to ensure their preferences were still known. People’s communication needs had been assessed and met. People’s relationships and social interests were supported. People were able to enjoy and engage in meaningful activities. People had opportunities to be involved and improve the service. A complaints process was in place. People had the opportunity to discuss their end of life wishes.
The building was suitable for people living at the service and had been adapted to people’s needs. People enjoyed their meals and were monitored for any weight loss.
The provider demonstrated a duty of candour in their approach to complaints management. Checks on equipment and premises were in place to help reduce risks. The management team had acknowledged staff morale and were focussing on achieving good outcomes for staff and people.
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 30 December 2020)
Why we inspected
The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury and died. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.
The inspection was also prompted in part due to concerns received about falls management, staffing, medicines and management of the service. A decision was made for us to inspect an examine those risks.
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, effective 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.
Following our inspection, the provider began to implement a range of actions designed to mitigate the risks found.
The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kiwi House 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 we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified four breaches in relation to safe care and treatment, safeguarding, staffing and 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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Each part of the service had a dining room and a lounge. The communal areas were clean and spacious and there was a hairdressing salon, cinema room and a bar.
We found the following examples of good practice.
¿ The provider had installed a visitors pod in the garden which meant that families could have a comfortable, relaxed visit without risk.
¿ Staff had received training in donning and doffing personal protective equipment (PPE), and we saw this was accessible throughout the home and staff used it in accordance with the most up to date guidance. Staff had received further training in Covid-19 and infection control.
¿ The service had six separate units which could be isolated from the rest of the service during an outbreak to ensure there was limited cross contamination.
¿ The infection control policy was up to date. We reviewed audits which reflected actions had been taken to maintain the standards within the home. There was a Coronavirus Policy and procedure and also national guidance which was kept updated.
¿ There were no visitors allowed in the home and they had found alternative ways for family members to keep in contact with those living at the service. Only essential medical professionals had entered the home during the outbreak.
¿ At the initial outbreak, 14 people tested - positive and were isolated on the middle floor of the three storey building. The floor has the cinema and bar which weren't being used during the outbreak, these served as areas for staff to don and doff PPE.
¿ The home was clean, and we saw staff carrying out a deep clean of a room of one person who had been infected and had completed their isolation period.
Kiwi House 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.
Kiwi House is purpose built and accommodates 78 people across three separate floors each of which have additional separate units and adapted facilities. One of the units specialises in providing care to people living with advanced dementia. At the time of our inspection there were 72 people using the service.
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 2008 and associated Regulations about how the service is run.
At our previous inspection in July 2017 we found people did not always receive their medicines as prescribed. Improvements had been made and medicines were, in the main, managed safely. Some areas of managing medicines required further development. We found staff did not always follow procedures for ensuring medicines were used within the recommended expiry date and monitoring charts were not consistently in place for transdermal medicines.
At our previous inspection we found the provider did not have effective systems and processes for monitoring and improving the quality of care. Improvements had been made and detailed audits and checks were in place. Action plans had been developed to identify improvements and ensure these were made in a timely manner. People and relatives were supported to share their views of their care and these were used to make improvements and drive the development of the service.
Risks to people's health and wellbeing had been identified and assessed. Some records had not been updated to reflect people's current needs.
Staff understood about safeguarding and the many different types of abuse. They knew how to report any concerns they may have, within the structure of their organisation or externally or other regulators or local authorities.
Staff had good knowledge of how to keep people safe and had been employed following robust recruitment and selection processes. There were sufficient staff deployed to meet people's individual needs.
There were arrangements in place for the service to make sure that action was taken and lessons learned when accidents or incidents occurred, to improve safety across the service.
Staff received induction, training and supervision to provide them with the necessary skills and knowledge to meet people's needs.
People were supported to have enough to eat and drink. People were assessed for the risk of malnutrition and when required specialist advice and support was sought.
People's rights were upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. Staff supported people in the least restrictive way possible.
People had developed positive relationships with staff, who were kind and caring and treated people with respect and dignity. People were supported to maintain their independence.
People and their relatives were supported to be involved in the development of their care and information was provided to enable people to access and understand information.
Staff provided care that was focussed on each person as an individual. People and, where appropriate, their relatives, were encouraged to make decisions about how their care was provided. Care plans included information about people's history, likes and dislikes and preferences which supported staff to provide personalised care.
People had access to a varied activities programme. This helped to provide people with meaningful stimulation and reduced the risk of people becoming socially isolated.
People were supported to raise concerns and complaints. These were investigated and used to bring about improvements in the service.
The management and leadership within the service had a clear structure and was used to support and develop the care staff provided. Staff felt supported and valued. Diversity was recognised, respected and promoted within the service.
The provider is registered to provide accommodation for up to 78 older people living with or without dementia in the home over three floors. There were 62 people using the service at the time of our inspection. This was the service’s first inspection since registration with the Care Quality Commission (CQC).
A registered manager was in post and was available throughout the inspection. A registered manager is a person who has registered with the 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 did not always receive their medicines as prescribed.
Risks were not always managed so that people were protected from avoidable harm. Staff did not always follow safe infection control practices.
Staff understood their duty to protect people from the risk of abuse and knew how to report any concerns. Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices.
People’s rights were protected under the Mental Capacity Act 2005, however, documentation was not always completed to fully demonstrate that capacity was being considered on a decision by decision basis and that decisions were being made in people’s best interests.
People told us they received sufficient to eat and drink but the mealtime experience required improvement in one dining room and food and fluid documentation was not always accurately completed. Adaptations could be made to the design of the home to better support people living with dementia.
Staff felt supported and received induction, training and supervision. Appraisals were in the process of being arranged. External professionals were involved in people’s care as appropriate.
Staff were kind and knew people well. Staff responded effectively to people showing signs of distress. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.
People received care that respected their privacy and dignity and promoted their independence. People could receive visitors without unnecessary restriction.
People received personalised care that was responsive to their needs. People felt they were supported to access activities that met their needs.
Care records contained information to support staff to meet people’s individual needs.
A complaints process was in place and staff knew how to respond to complaints. Complaints were responded to appropriately.
Systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective. As a result the provider and registered manager were not fully meeting their regulatory requirements.
People and their relatives were involved or had opportunities to be involved in the development of the service. Their feedback was acted upon by staff. Staff told us they would be confident raising concerns with the management team and appropriate action would be taken.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.