Kineton Manor Nursing Home

Kineton Manor Nursing Home provides accommodation, nursing and personal care for up to 53 older people, who may have dementia. There were 51 people living at the home at the time of our inspection.

People's experience of using this service

The provider completed quality checks in key areas of the service which had driven improvements. People received their medicines as prescribed however, some improvements in the safe management of medicines were identified. The provider later sent us information about how they were going to strengthen their medicines management processes to ensure any shortfalls were quickly identified.

Staffing levels met people’s needs. Staff supported people in an unrushed manner and were able to respond to requests for support without any undue delay.

Staff understood the importance of risk management and changes in risks to people's health and wellbeing were shared during the handover between shifts. Staff were trained in safeguarding and confident in reporting safeguarding concerns.

The home was clean and tidy and infection control practices minimised the risks of infections spreading.

Relatives spoke positively about their experiences of the home and the care and compassion demonstrated by managers and the staff team. All the staff we spoke with told us they were confident in raising any concerns and would not hesitate to do so knowing they would be listened to.

The provider had recently restructured the management team to make it more effective and was responsive to feedback. Following our inspection the provider took immediate action to review their medicines protocols and procedures.

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 Outstanding (published 19 May 2019).

Why we inspected

The inspection was prompted in part due to information received about the management of medicines and a culture of staff not feeling able to raise concerns. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 outstanding 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 Kineton Manor on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kineton Manor Nursing Home provides accommodation, nursing and personal care for up to 51 older people, who may have dementia. There were 51 people living at the home at the time of our inspection.

People’s experience of using this service:

At our last inspection in May 2016, the service was rated requires outstanding overall. The key questions for safe, effective and responsive were rated good and the key questions caring and well-led were rated outstanding. At this inspection we found the evidence continued to support the rating of outstanding. The continuous improvement in the service had resulted in a further outstanding rating for the responsive key question.

People told us that they were extremely happy with the service they received. They praised the atmosphere within the home and spoke of the dedication of both managers and the wider staff team.

The service was led by a highly motivated and compassionate registered manager who continued to explore ways to improve the service to ensure people received high quality care. Staff were proud to work at Kineton Manor and spoke very positively about the guidance and motivation provided by the registered manager and the senior staff team.

There were enough highly trained and skilled staff to meet people’s needs. There was a strong commitment to providing staff with the opportunities to develop in their role and take extra qualifications.

Staff spoke about people in a very compassionate manner, were knowledgeable about people’s history and background and valued them as individuals. People were respected for who they were and staff understood the importance of protecting people's rights in line with equality legislation.

The service offered people opportunities to meet their individual cultural, psychological, spiritual, emotional and social needs, whatever their abilities. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff worked in partnership with a multi-disciplinary team to enable people to live healthier lives or to manage long term medical conditions. The registered manager and staff continued to demonstrate an extremely strong commitment to supporting people and their relatives before and after death.

The provider’s policies and procedures protected people’s rights and enabled them to live safely, free from abuse, neglect and discrimination. Risks to people in their daily lives were assessed and plans were in place to reduce these. People’s medicines were managed safely and infection control procedures protected people from the risks of cross infection.

People were supported to maintain a healthy diet. Meal times were social occasions and people had a choice of meals.

The provider used a range of strategies to check people and their relatives were satisfied and confident in the standard of care provided within the home. The service had systems to continuously monitor, assess and improve the service provided.

The provider was a member of several good practice initiatives and research projects where they worked in partnership with other organisations to make sure they were following current best practice. Knowledge was shared to improve outcomes for people in the wider care sector.

Rating at last inspection:

At our last inspection which was published 19 July 2016, the service was rated outstanding.

Why we inspected:

This inspection took place as part of our planned programme of inspections, based on the rating of outstanding made at our last inspection.

Follow up:

We will continue to monitor this service according to our inspection schedule.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The registered manager had been in post for thirteen years. 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.

The service provides accommodation, nursing and personal care for up to 51 older people, who may have dementia. Fifty people were living at the home at the time of our inspection.

People were at the heart of the service. People, relatives and staff told us they felt like family because of the love and care they all felt from, and for, each other.

People were cared for and supported by kind and caring staff, which made them feel special. Relatives were inspired to become volunteers at the home so they could give back some of the kindness and support they had received.

Relatives felt welcomed at the home and shared in caring for their relations. Staff were valued for their contribution to making people’s experience of the service the best it could be. Staff were proud to work at the home and pleased with the thanks and compliments they received.

The end-of–life care people received was as personalised, caring and supportive as a specialist hospice service. Health professionals and relatives complimented the service on the end–of-life care that the whole staff team delivered.

The provider’s philosophy, vision and values were understood and shared across the staff team. People’s opinions and suggestions were respected and used to improve the quality of the service.

The registered manager was a role model for staff who were all inspired and motivated to deliver the highest quality service. The provider, staff and relatives respected the registered manager’s professionalism and recognised their leadership was inspirational.

The registered manager shared their professional knowledge and experience with staff and implemented innovative methods to ensure all staff understood how they contributed to people’s experience of the service.

The registered manager worked with educational and research organisations to improve the quality of people’s treatment. The quality of care and treatment at the home was sufficiently well recognised that it was a university approved training establishment for nurses.

People received effective care, support and treatment because staff had training, skills and knowledge that was relevant to people’s needs. Healthcare professionals were complimentary about the quality of care and praised the effectiveness of people’s treatment. The staff worked as a team to support people with their health and social needs and staff understood how to improve people’s sense of well-being.

All the staff were supported to maintain their professional development by the registered manager. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having the capacity to make all of their own decisions, records showed that their families, legal representatives and healthcare professionals were involved in making decisions in their best interests.

Risks to people’s nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs and staff supported people to maintain a balanced diet.

Staff monitored people’s appetites, moods and behaviours and referred them to other healthcare professionals when their needs or abilities changed. Staff ensured people obtained advice and support from other healthcare professionals to maintain their health.

People and their families were involved in planning their care, to ensure their care plans matched their individual needs, abilities and preferences. Care staff showed understanding in caring for people, because they understood people’s individual motivations and responses.

People were supported maintain their important relationships and their personal interests. Staff supported and encouraged people to celebrate important personal and national events. People were encouraged and supported to attend exercise and activity sessions. Entertainments were provided at the home that people remembered with pleasure.

There were enough staff on duty to meet people’s physical and social needs. The registered manager checked staff’s suitability to deliver personal care during the recruitment process. The premises and equipment were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored in their own rooms and administered safely.

Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. Staff understood the risks to people’s individual health and wellbeing and risks were clearly recorded in their care plans.

Forty-nine people were living at the home on the day of our inspection. Many of them were not able to describe how they were cared for and supported because of their complex diagnoses. We observed how care was delivered and talked with 13 people, two relatives and a visiting specialist nurse about what it was like to live at the home.

We reviewed four staff files, two volunteers' files and three care plans. We looked at records of complaints, accidents and quality assurance audits. We saw the results of surveys undertaken by the provider of people who lived at the home, their relatives, the staff and of allied health professionals.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The care plans we looked at showed that risks to people's health and well-being were assessed. Care plans described the actions staff should take to minimise the identified risks.

People were cared for in an environment that was safe, clean and hygienic.

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider checked that the staff employed to work at the home were suitable and had the skills and experience needed to support the people who lived at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No applications had needed to be submitted according to the local authority policies and procedures. The deputy manager knew about a recent judgement by the Supreme Court in relation to (DoLS), and was taking action to ensure they complied with any changes in the local authority's policy and procedures.

Is the service effective?

People told us they were happy with the care they received and their needs were met. It was clear from our observations and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us, "I am very happy. You can't fault it', 'The staff are very good. What more can you ask for?' and 'We are well looked after.'

Is the service caring?

People were supported by kind and attentive staff. People told us they were able to get up and go to bed when they wanted to, and always had a choice of meals. Relatives told us, 'It's the best nursing home' and 'If we asked X if she wanted to move, she would say 'no'.'

We saw that care workers were patient and encouraged people to make their own decisions. A nurse told us, 'For people with dementia, we learn what their gestures and body language mean.'

Is the service responsive?

People's needs and abilities were assessed before they moved into the home. The records we looked at confirmed that people had been asked about their likes, dislikes, preferences and interests. We saw people were supported to follow their own interests and join in group activities if they wanted to. People told us they went out to places that interested them.

Is the service is well led?

Staff had a good understanding of their role and responsibilities for delivering a quality service. Staff told us they were informed of the outcome of the quality assurance audits and knew about any actions they should take to improve. A nurse told us, 'We are in a very good place. I am very proud to work here.'

The provider conducted internal quality reviews and actively consulted with people, their relatives, the staff and external health professionals through surveys and meetings. We saw that complaints were investigated thoroughly and actions taken to provide a satisfactory resolution.

In the four care plans we looked at, we saw that people's care was planned according to their needs and dependencies. A relative we spoke with told us they felt well informed about their relation's care, treatment, and their changing needs. One person we spoke with told us, 'Staff came and helped me very quickly when I rang my buzzer. I feel altogether very safe, the staff are very efficient.'

We found the provider had a system for managing medicines safely. All the staff we spoke with were clear about their responsibilities for administering medicines.

The two care staff we spoke with told us they felt well prepared to work with people because they had a comprehensive induction when they started working at the home. They told us they were supported in their day to day practice by the nurses and manager. The two staff files we looked at included records of their induction and training and of their regular meetings with the manager.

The manager had a system for monitoring the quality of the service, which included regular audits by staff and external professionals. The manager responded to people's feedback and took actions to improve the quality of the service.