Kineton Manor 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The outcomes of accidents and incidents were shared with staff so they could learn and improve practice when things went wrong. For example, lessons learnt were discussed in staff meetings, supervisions and daily handovers. Staff told us reflective practice was also used to reinforce learning and share problem solving to improve people’s outcomes. A senior member of staff explained, “We really work hard to instil a culture of listening and sharing our experiences and best practice.” This was reinforced by the registered manager who commented, “We ask staff to do personal reflection on what they could have done better to prevent any incident. I always tell them that mistakes happen, but we should learn from the mistakes."

The registered manager analysed accidents and incidents to ensure appropriate action had been taken to keep people safe and to identify trends or patterns at service level. They used this information to implement any required changes in staff practice or people’s planned care.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider followed the "red bag scheme" which is a pathway of care for people in care homes who require emergency hospital treatment. The bag contains essential items for a hospital visit including information about a person’s medicines and allergies. The provider also printed essential information from their electronic care planning system, so other healthcare professionals understood the support people needed with eating, drinking and moving around safely. This promoted good communication channels to bridge gaps in care provision.

Staff or relatives supported people to attend planned external medical appointments. This provided people with practical and emotional support and ensured effective communication to inform decision making. There were processes to incorporate advice and changes to people’s treatment into their care plans and update other healthcare professionals involved in people’s care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People or their relatives felt they were safe living at Kineton Manor Nursing Home and were able to provide a variety of reasons to substantiate their views and feelings. Comments included: “It is definitely safe here; the place is secure and the care very good”, “I think [Name] is in very safe hands. They (staff) all like him and they know him very well and they are like that with everyone” and, “I am absolutely safe here, there are some amazing staff, and they are so thoughtful.”

Staff, whatever their role in the home, understood their responsibility to report any concerns people were at risk of harm, discrimination or poor practice. Staff said they would escalate concerns either internally or externally to partner organisations if they felt the right action had not been taken to keep people safe. One staff member told us, “I would definitely report it to the senior nurse and the management and if there was no action, I would report it through the hierarchy levels and I would whistleblow." When we gave another staff member a safeguarding scenario, they responded, “I would go and report it to the manager. If they didn’t do anything, I would go over my manager’s head, and it would be the council because it is a safeguarding case. The majority of the residents here need our help, they are all human beings, and they deserve our respect."

The provider had safeguarding and whistleblowing policies and procedures. The registered manager was aware of when they needed to report concerns to the local authority safeguarding team.

When receiving care and treatment, people can only be deprived of their liberty with the appropriate legal authority. In care homes, this can be done through a procedure called The Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act (MCA) 2005. We checked how the provider managed DoLS within the home. Where people had restrictions in their care plans, they had been assessed as not having the capacity to consent to, the provider ensured DoLS applications had been submitted to the relevant supervisory body. Nobody had any conditions on their approved DoLS at the time of our inspection.

The provider worked with people to understand and manage risks. However, daily records did not always accurately reflect the use of risk management strategies.

Where people had been identified as being at risk of choking and required modified food and fluids, this was recorded in their care plans. However, daily records did not always accurately reflect how those risks were being managed which could have resulted in people experiencing choking episodes. The registered manager had identified this as an area for improvement and was addressing this with staff.

There were clear and personalised risk assessments covering other areas of people’s health and safety. This included people’s mobility and their risk of falling. Where people had more complex clinical needs, there was detailed guidance for staff on how to provide safe care and treatment and mitigate any associated risks. For example, when people had skin damage or received their nutrition or medicines through a tube directly into their stomach.

The provider did not always detect and control potential risks in the care environment.

Environmental checks were completed regularly and included water quality and fire safety. However, we found some fire doors for bedrooms closed quickly, without slowing before closing into the door jamb. The provider agreed to adjust the doors so when they closed, they did not impact on people’s safety.

Areas of the building which needed to be secured to meet people’s safety needs were not always appropriately secured. Some doors with stickers that said ‘keep locked’ had been left open. In 1 unlocked cupboard, we found continence products and an electric device with exposed electrical circuitry. These issues had not been identified by staff as a potential risk.

The home was undergoing a refurbishment programme to provide improved facilities and enhance the presentation of some areas of the home. The provider took action to address the environmental issues we identified on the first day of our inspection.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and their relatives told us there had been some recent variation in staffing levels. However, they said this had been addressed by the new registered manager and staff were available when they needed them. Comments included: “You can always find someone if you need a member of staff” and “To be honest there always seems to be lots of staff about and I get to see the same regular 3 or 4 faces.” Our observations showed staff were visible and available to respond to people’s requests for assistance.

Staffing levels were based on people’s assessed needs. There were ancillary staff to maintain a clean environment and kitchen staff prepared people’s meals and drinks. This allowed clinical and care staff to focus on providing people with safe care. The registered manager told us the staff team worked well together, and they were confident there were enough staff to meet people’s physical and emotional needs. One member of staff told us, “I feel the number of staff is adequate to meet the needs of the residents. If someone asks for help, staff try to respond as quickly as they can.” Another member of staff told us they had sufficient time to provide support at the time people preferred and in accordance with their care plans.

The provider had processes to check the suitability of staff before they commenced employment. Additional checks made sure all safe recruitment checks were made and recorded. Staff were supported through an induction process and on-going supervisions, training and competency checks.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We saw positive practices to minimise cross infection. Handwashing signage was displayed in communal toilet and bathroom areas, and all bins were foot operated, meaning less risk of cross contamination. Personal protective equipment (PPE) stations were available and stocked. Staff were seen to use the appropriate PPE at the required times.

Staff with housekeeping responsibilities understood their role in promoting good infection control practices. One member of domestic staff described how they used different coloured cleaning equipment in specific areas of the home to prevent cross-contamination. However, some internal woodwork and wooden furniture was worn and damaged which made it difficult to clean. The registered manager told us the ongoing refurbishment would address these issues.

There were processes in place to respond to any infections in the home to mitigate the risks of them spreading.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People and their relatives shared no concerns about the provision and administration of their medicines. One person told us, “I have to take quite a few tablets, and they (nurses) are very good with bringing the medication.” Another person commented, “I always have a sleeping tablet at 8pm and that is always delivered on time.” A third person explained they were on a complex medication regime and had no concerns about how their medicines were managed.

Medicines were stored, managed and administered in accordance with best practice guidance. Care plans described people’s preferences for how they took their medicines and what support they needed. Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely.

Medicines that required extra checks due to their potential for misuse were managed in accordance with legal frameworks. There were processes to ensure people received their time specific medicines as prescribed, and medicines administered via a patch applied directly to the skin were managed in accordance with manufacturers’ guidelines. Regular audits of medicines were completed, and any medication errors were investigated and reflected upon.