Archived: Kettlewell House Nursing Home

Kettlewell House Nursing Home is a care home providing personal and nursing care for up to 37 people, many of whom are living with a health condition, mental health condition or dementia. People live in the main nursing home, or more independently in one of the suites or flats that are on the same site. Everyone receives the regulated activity of personal care.

Some people who did not live in the service also attended the day centre at the service and whilst there in the home, they received the regulated activity of personal care. At the time of our inspection, 33 people were living at the service.

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

People spoke highly of the registered manager, praising their knowledge and management oversight of the service. However, we found the provider operator had failed to support them by making some necessary changes to some carpeted areas in the service.

People were happy living at Kettlewell House. They told us they felt safe and they were cared for by a sufficient number of staff who were kind, caring and showed them respect and dignity.

People’s individual risks had been identified and staff kept people safe through good care management and a knowledge of how to recognise and report potential signs of abuse.

People’s medicines were managed well and where people required the input of external health care professionals this was sought promptly to help ensure people maintained a good level of health.

Staff were well trained and felt supported by management. They demonstrated a good understanding of people’s needs and provided person-centred care.

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.

People told us they enjoyed the food they were provided with and liked the opportunity to participate in the activities that were arranged for them.

Relatives were very happy with the care provided to their family member and they were given the opportunity to air their views or give feedback through relatives meetings. The management team had good governance arrangements in place to continually assess the quality and safety of the service. They worked well with external agencies to respond to people’s needs.

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

Rating at last inspection and update

The last rating for this service under the previous provider operator was Requires Improvement (report published 27 August 2019).

At that inspection, we found breaches of regulation in safe care and treatment, person-centred care, premises and equipment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider notify CQC of all incidents of potential abuse, review staff deployment, review the Mental Capacity Act 2005 code of conduct in relation to people who lacked capacity, provide additional specific training to staff and improve the activities on offer to people. At this inspection we found the provider had acted on those recommendations and had made improvements.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. It was also because since that inspection the provider operator had changed.

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.

Follow up

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

We were assured that this service met good infection prevention and control guidelines.

The service had robust policies and processes in place for visitors to the service and people moving in. These helped protect everyone living at Kettlewell House.

Where people had tested positive for COVID-19 they spent an isolation period in their room and were cared for by a dedicated cohort of staff.

People told us staff always wore their masks and wore gloves when carrying out personal care. We observed staff wearing their Personal Protective Equipment (PPE) appropriately throughout our visit and we heard how there had been no shortage of PPE both for care and housekeeping staff.

The service appeared clean and hygienic and people said staff were, “Always cleaning.” High touch points, such as keypads, medicine trolleys and computer keyboards had sanitising gel stations or wipes nearby for staff to wipe equipment down between use. Staff were able to describe what was expected of them when removing their PPE and how often they should wash their hands or sanitise. All of this helped reduce the spread of infection.

Social distancing had been considered within the internal and external layout of the service. Chairs in communal areas were spaced apart and the garden and staff room were set out to ensure people and staff were following national guidance in relation to numbers of people gathering together.

The registered manager had supported people and staff throughout the pandemic. They ensured people’s spirits were lifted through activities and contact with family members and raised staff morale through words and actions. Staff told us they could not have been better supported.

Further information is in the findings below.

Kettlewell House Nursing Home is a care home providing personal and nursing care for up to 37 people, many of whom may be living with dementia or a mental health condition. People can live in the main nursing home or more independently in one of the suites or flats that are on the same site. At the time of our inspection, 36 people were living at the service.

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

People were cared for by a sufficient number of staff. However deployment of staff needed to be thought through to ensure that those people who required more monitoring received this but not to the detriment of other people’s care. People may be at risk of harm due to the complex needs of some people living at the service. Although one to one care was provided, this was not consistent throughout the day. Where people had accidents and incidents, there was a lack of recording all of the incidents relating in particular to one person which meant the registered manager may not have full oversight of these to check for themes and trends.

People lived in an environment that was not suitably adapted for them, particularly if they were living with dementia. There was also a lack of robust infection control processes in place.

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 consistently support this practice.

Although activities did take place, further work was required to ensure these were available more often and were person-centred and meaningful to people. People’s records did not always reflect sufficient information for staff to know how best to care for people and people’s end of life wishes were not always recorded.

Although quality assurance audits were completed by both the registered manager and registered provider, actions were not always taken when shortfalls were identified.

People received the medicines they required and were cared for by staff who were recruited through a robust process. People had access to health care professionals when they needed it and access to a choice of foods and sufficient drinks. People told us they enjoyed the food and they were encouraged in their independence as adapted cutlery and crockery was available.

Professionals said staff were competent and that they knew people’s needs and worked well with them and people in a collaborative way.

People were cared for by staff who were kind to them. Staff respected people and spoke to them in a polite and courteous manner. People were cared for by staff who felt supported and who had undergone an induction and relevant training. People, relatives and staff all spoke highly of the registered manager and where feedback form staff or people was received, the registered manager used this to develop an action plan on how to improve 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 (and update)

The last rating for this service was Good (published January 2017). Since that rating, the registered provider of the service has changed.

Why we inspected

This was a planned inspection based on our methodology for inspecting services when the registered provider changes. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the registered provider needs to make improvements. Please see the Safe, Effective, Responsive 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.

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.