Kenilworth Grange Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This service scored 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People were assessed prior to being admitted to Kenilworth Grange. This was completed in conjunction with hospital teams for the ‘discharge to assess’ beds, and in person by the registered manager when being admitted from the community. Risk assessments and care plans were completed within a specified timeframe, to ensure staff had access to the information they needed as soon as they took over people’s care.

People’s needs were regularly reviewed. The provider operated a ‘resident of the day’ system, to ensure that all records were reviewed at least monthly, if not before. Paperwork did not always detail how people had been involved in reviews of their needs. However, most people or their relatives told us they had been involved and knew what was recorded in their care files.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People in the ‘discharge to assess’ beds routinely had their food and fluid monitored and their weight was checked weekly. This evidence was used by multi-disciplinary teams to inform decisions as to the most appropriate level of care the person required after their period of assessment. Regular clinical meetings ensured people’s health and wellbeing were monitored.

Information about people’s individual dietary requirements was available in the main kitchen and the kitchenette areas on each unit. The head chef demonstrated a good knowledge of people’s individual dietary needs and told us they were updated of any changes or if people were unwell. The provider used the International Dysphagia Diet Standardisation Initiative (IDDSI). IDDSI is a standard for describing food textures and drink thicknesses for people with swallowing difficulties.

The provider had mandatory training courses staff were required to regularly complete to ensure their practice reflected current guidance. One staff member told us, "It is perfect, we get training all the time. If you haven't done your training, they come and remind you."

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us information was shared at handovers between shifts, so they knew the care people needed that day. One staff member told us, “We get handover every morning before we start our shifts. I think it is quite good as a carer because I get updated and told anything that has happened so when I start my shift, I know what I am doing."

Some relatives, staff and healthcare professionals felt communication in the home could be developed further. The provider made improvements to the handover process during our inspection so that they could be assured all staff had received accurate and up to date information about people. The registered manage told us they were committed to improving communication in the home.

A GP visited the home every day to assess and monitor those people in the ‘discharge to assess beds.’ A frailty nurse visited the home weekly and following an initial triage, people’s clinical needs were discussed with GPs from the local surgery via zoom calls later in the day.

A range of healthcare professionals told us of the good working relationships they had developed with staff in the home. One professional told us, “I have always found (registered manager), her administrative staff and nursing staff to be open, friendly and always available to discuss anything I may need to raise, or when planning discharges or admissions. (Registered manager) has an open door policy in her office and I am always welcomed in to see her.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff told us they would immediately report any changes in people’s health to the nursing staff, knowing they would be listened to. When referrals needed to be made to external healthcare professionals such as dieticians or speech and language therapists, these were timely and any advice provided was incorporated into people’s care records.

People were encouraged to engage in gentle activity to improve their balance and mobility and their social wellbeing. A member of the activities team told us, “When we started doing walks and trips you could see how much happiness it could bring to people and it keeps people active. We do lots of physical exercises, it keeps them moving. Especially with Parkinsons they get stiff muscles and you can see how much better they are after. People are so much more active throughout the day after exercises."

Care plans detailed the support people needed to maintain their oral health. This had been identified as an area for improvement within the home and was being closely monitored by management and leaders.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There was a lack of detail in the records maintained when people’s nutritional intake needed to be monitored because they were at risk of not eating and drinking enough to keep well. We saw some documentation where staff had written ‘pureed meal’ with no description of what food was given, the portion size or how much food had been consumed. Accurate recording helps determine if the person’s nutritional care plan needs reviewing to meet the person’s needs. It also helps other healthcare professionals make decisions relating to people’s treatment and identifies when people’s planned outcomes are not being met and they need to be encouraged to eat and drink more.

For people at risk of skin breakdown, outcomes were also not consistently monitored, in line with assessed needs. One person’s care plan stated they needed repositioning every 2 hours, however their records indicated a 4 hourly repositioning schedule was being followed. This increased the risk that planned preventative measures were not being delivered as intended.

Despite these shortfalls, clinical care plans were generally clear, and where health professionals had provided guidance, this was recorded and accessible.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People told us staff asked for their consent when they required support with personal care.

Staff understood their responsibilities to obtain consent from people and we observed staff asking for consent before assisting people with meals. One staff member told us, “We have to ask people about where they want to spend their day. It’s their choice, we don’t force anybody.”

The provider had systems and processes that ensured the Mental Capacity Act 2005 (MCA) was followed to support people who lacked capacity to make specific decisions. Mental capacity assessments and best interest decisions were completed to ensure specific decisions made on behalf of people were made lawfully. Consent preferences were documented in people’s care plans. However, not all staff were able to explain which people had restrictions approved in their care plan and why. Several staff told us no one would be given the codes to the doors to exit the home, whether they had restrictions approved or not. This meant there was a possibility people were not free to move around or leave the home without supervision, even when it would be safe for them to do so. Despite this, we saw examples of when people had been out of the home independently and staff had monitored and assessed this to ensure people were safe. The registered manager and the provider assured us they would enhance staff training in this area.