Archived: Kettlewell House Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.
 

This service scored 50 (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 did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.
The provider did not always demonstrate care delivery aligned with what people’s care plans set out. For example, one person’s care plan noted they had ‘always been very sociable and loves to dance, loves to chat and has good verbal understanding and expression’. The care plan stated for staff to try to encourage this person to come down to the lounge everyday so they can enjoy the entertainment and engage with other people. However, we observed this person was not always empowered to do this, and when they expressed, they wanted to, their independence and choices were not supported or promoted by staff. Relatives told us, “The place seemed brighter and changed but it’s gone down again.”
 

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.
We found people within the service had diverse and complex needs. Staff could not always identify and take appropriate action when there was a gap in a person’s care. One staff told us they did not have enough staff to ensure they would not have to feed 2 people at the same time. Staff said, “I think we are managing, but if we had more help at lunchtime, so we don’t have to rush it would be better for the [people]. If we do feed people – 2 at a time .”
People did not always experience continuity of care. One person told us, “I’m having one carer with the hoist which isn’t right. I have a man, and he had to have a new girl who doesn’t know what to do”. This meant care provision was not always delivered in line with people’s individual and assessed needs.
 

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.
We found some information such as food menus were not easy to read and people struggled to clearly understand them. The leadership team told us they were aware of the inaccessibility of this and were looking to make changes to the format of this information.
We completed observations during mealtimes and found not all people were supported to make informed choices according to their needs and wishes with formats tailored to individual needs. For example, we observed people in one dining area were supported with show plates. However, in another dining area, no show plates or photos were provided, and the staff did not clearly inform people what their meal was. This meant people could not always access the information they needed, in a way they could understand.
The provider failed to demonstrate provision of information in a clear, embedded system and process was in place for families to understand the complaints process. Some relatives told us, “I don’t know about the complaints process. But I would tell the manager issues.” Another relative said, “I don’t know who I’d go to report, the nurses I suppose.” This did not demonstrate the service appropriately supported people to give their feedback, share ideas or make a complaint.
 

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.
The provider failed to maintain a complete complaints log, and evidence correspondence for all complaints submitted. We requested to see the complaints folder and found only 1 complaint was enclosed. The investigation report and conversation with family was also not included in this folder. The regional director was unable to locate any other complaints folders. We asked the interim manager if they had access to previous complaints and they confirmed they were not sure if there were any unlogged complaints, and they were trying to create a more detailed complaint folder. However, this demonstrated the provider had failed to maintain oversight and monitoring of any themes/trends arising from complaints, and the provider failed to demonstrate how these were being used to drive improvement. This also meant the provider failed to establish and maintain an effective system and process for storing complaints. The provider did not demonstrate all concerns were captured, analysed and resolved to ensure incidents were not repeated, and trust was maintained with people and their families. Keeping clear and accurate records would evidence provider acted in an open and transparent way.
We made multiple requests to the provider for the duty of candour letters, both during and following our onsite visit. The provider failed to evidence these letters, and evidence they were compliant with duty of candour when notifiable safety incidents happened. This meant there was ongoing risk people, and their families may remain unsupported, uninformed, and unaware of corrective actions, prolonging harm and uncertainty.
Relatives we spoke with told us following serious notifiable incidents, “We’ve never received a satisfactory answer about it.” Another relative told us, “[Nurse ] said that there would be a report, but I haven’t received one.” This failed to provide assurance and demonstrate the provider was always transparent and open with people and their relatives when something went wrong, or allegations were made. This meant there was a loss of trust, emotional distress, and inability for families to challenge or follow up on care concerns.
 

The provider made sure that people could access the care, support and treatment they needed when they needed it. We reviewed people’s care records and found appropriate referrals and input from external partnership agencies was evident when required. This included access to a dentist and foot care specialist.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.
We found people’s experience of mealtimes was inequitable. Staff told us, “Everyone doesn’t eat at the same pace. If we had more time they would have more comfort.” We found no large menu displayed for people to see and for those people living with dementia, they were unable to know what was on offer whilst they were in the dining room waiting.
The provider did not ensure they always supported equity in experiences and outcomes by ensuring care planning for individual people supported this, and systems and processes were in place to ensure all people experienced a positive and supportive mealtime experience.
 

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.
We reviewed people’s care records and found some records did not contain evidence of future planning to support people with major life changes including when they were coming to the end of their life. This put people at risk of not receiving person centred care or experiencing positive outcomes if their health changed for worse.