Kitnocks House

About the service

Kitnocks House is a nursing home providing personal and nursing care to 63 people. People living at the home had high complex support needs in relation to their diagnosis of dementia, mental health conditions, learning disabilities and physical disabilities. At the time of the inspection there were 63 people using the service.

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

People were given their medicines in a way that met their individual needs. The provider had implemented a new electronic medicines administration and management system during the inspection. They were monitoring and updating the system as required promptly to fully embed the new system. The service had systems and processes in place for the safe storage, administration and use of medicines. However, these processes were not always followed, to ensure medicines were stored in line with recommendations. We have made a recommendation about the storage for some medicines.

We received mixed feedback from relatives about the staffing levels within the home. We observed safe staffing levels throughout the inspection and staff appeared unhurried and responsive to people. The provider was open about the challenges they had faced recruiting staff. They had created a recruitment team and implemented different initiatives to encourage recruitment and retention of staff. Safe recruitment processes were in place. Staff files contained the information required to aid safe recruitment decisions.

The provider had arrangements in place to assess and monitor risk. Risks to people were recorded in their care plans. 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. There were appropriate policies and systems in place to protect people from abuse. The manager understood their responsibilities to safeguard people from abuse.

Accidents and incidents were monitored, reviewed and analysed for trends and patterns. The provider carried out monthly and quarterly analysis of all accidents and incidents which had resulted in positive outcomes for people.

People were supported to maintain contact with their family members and friends throughout the pandemic. The provider facilitated visits for people living in the home in accordance with government guidance.

The manager promoted an inclusive, value based and positive culture. The management team had implemented changes to make the home more robust to weather challenges. Staff were deployed flexibly across the home to ensure people’s needs were met. They were confident in the changes being implemented and had a clear rationale for the changes. Most staff told us they felt supported, valued and listened to. However, some staff felt communication could be improved.

There were systems and processes in place for monitoring the quality of care and used to plan improvements. Where the quality assurance audits identified issues, remedial action was taken.

Most relatives were overall positive about the home. However, some felt communication could be improved on. Relatives mostly confirmed they were involved in people’s care and were able to contribute to care planning.

The management and staff team worked in partnership with a variety of healthcare professionals and had developed good working relationships which supported positive outcomes for 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 17 February 2021).

Why we inspected

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kitnocks House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kitnocks House is a nursing home providing personal and nursing care to 63 people. People living at the home had high complex support needs in relation to their diagnosis of dementia, mental health conditions, learning disabilities and physical disabilities. At the time of the inspection, staff were caring for 62 people.

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

The management team and staff were not always following all of the Government guidance aimed at preventing and controlling COVID 19. Infection prevention and control practice was safe. Further work was required to improve safety around social distancing for staff working at the service. However, when this was discussed with the provider they took action to address this including discussions with staff and improving signage.

Relatives felt their loved ones were safe living at Kitnocks House and they were very much at the heart of the service. We received consistent positive feedback from relatives and professionals.

Medicines administration records (MAR) confirmed people had received their medicines as prescribed. However, where topical medicines were prescribed these were not always recorded.

Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

Most staff felt supported in their role, however morale was currently low due to the high use of agency staff.

Regular audits were carried out to assess and monitor the quality of the service. There were appropriate management arrangements in place and relatives were positive about the management in the home.

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 17 August 2017).

Why we inspected

The inspection was prompted in part due to concerns received about risks to a person’s skin integrity, staffing, covert medicines, fire training, low morale amongst staff and concerns or complaints not being dealt with. A decision was made for us to inspect and 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 coronavirus and other infection outbreaks effectively.

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. The overall rating for the service has remained the same. 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 Kitnocks House on our website at www.cqc.org.uk.

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.

At the last inspection in October 2014, the service was rated Good overall. At this inspection we found that they remained good.

The home had a registered manager who has been registered since June 2017. 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 felt safe living at Kitnocks House and risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies.

Relevant recruitment checks were conducted before staff started working at Kitnocks House to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

People were supported to take their medicines safely from suitably trained staff. Medication administration records (MAR) confirmed people had received their medicines as prescribed.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Staff received regular support and one to one sessions or supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction programme before being permitted to work unsupervised.

Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in place in the service supported this practice.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities. Staff knew what was important to people and encouraged them to be as independent as possible.

A complaints procedure was in place. There were appropriate management arrangements in place. Regular audits of the service were carried out to assess and monitor the quality of the service.

We returned to Kitnocks on 24 January 2014 and found that improvements had been made. Records demonstrated that best interest decisions were now being reviewed. We also saw that the provider had a system in place to monitor when best interest decisions were to be reassessed.

Staff were knowledgeable about Deprivation of Liberty Safeguards (DoLS) and people were supported appropriately in accordance to the measures that were put in place.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care records showed that each person had an assessment of their needs and a care plan, including risk assessments.

Staff we spoke with were knowledgeable about people's dietary requirements and were able to tell us who had allergies. The chef correctly confirmed people's dietary needs.

There were enough qualified, skilled and experienced staff to meet people's needs.The matron explained that the service had recently started to conduct monthly dependency assessments.