Kenmore - Care Home with Nursing Physical Disabilities

Kenmore - Care Home with Nursing Physical Disabilities is a residential care home providing personal and nursing care to 20 people at the time of the inspection. The service can support up to 26 people. The building is a converted older house with two ground floor extensions built around a courtyard.

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

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. However, concerns around people being encouraged to go to bed before night staff arrived was identified during the inspection.

Improvements had been made in the oversight of the service, although the recording of capacity and consent required strengthening to ensure records accurately reflected people’s needs. Communication between staff around people’s physical rehabilitation required strengthening.

People and their representatives said the care provided was safe and people were protected from harm. Risk was monitored and addressed, however this was not consistent. Pressure mattress settings were not set correctly which placed people at risk. However, there was no evidence to show people had come to harm as a result of this.

We have made a recommendation about systems of oversight in gaining user voice, checking pressure mattress settings and MCA systems and processes.

Safe recruitment practices were being followed. There were sufficient numbers of day time staff to meet people’s needs. Following our inspection, night time staffing levels were reviewed by the provider and increased to provide additional support.

Improvements were seen in the safe management of people’s medicines. Infection prevention and control standards were being followed and the premises was found to be clean.

People were supported to access healthcare services when they needed this support. People received enough to eat and drink from a staff team who understood associated risks. Staff received formal support through training and supervision sessions.

People and their representatives were given opportunities to feedback about the running of the home. The provider notified us of events which are reportable to the Care Quality Commission. The service worked in partnership with healthcare and other professionals to meet their 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 was requires improvement (published 3 December 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We made recommendations about the safe management of medicines and systems used to oversee delivery of care to people. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

We received concerns in relation to safeguarding people from abuse, meeting personal care needs and professional boundaries between staff and people. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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

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 remained required improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kenmore - Care Home with Nursing Physical Disabilities 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.

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

Some care plans were really detailed giving staff clear guidance to follow, but others lacked detail. Staff were not consistently recording when they had met a person’s care needs such as postural changes and oral hygiene needs. This meant the service was not able to evidence care had been provided on each occasion or that an accurate record was maintained.

The provider had not notified CQC of significant events as required by legislation.

Audits and checks were carried out; however, these were not always effective in identifying areas which needed to be improved. We have made a recommendation about quality improvement processes.

An electronic medicine management system was in place which was effective. However, improvements were required in medication management. We have made a recommendation about the management of some medicines.

We looked at how the service managed risks to people and found some improvements were required in how the service assessed and managed risk. Some risks were managed well, but others had not been identified to ensure the necessary control measures were in place. People told us they felt safe and they liked living at the home.

Staff had not always recorded accidents and incidents. Where reported, the registered manager had put in measures to prevent recurrence but a deeper analysis to find the root cause of the incident was often missing. There had been several incidents and ‘near misses’ involving temporary agency staff. Due to the complexity of the needs of people at the service, improvements need to be made in the induction and competence checks on temporary staff.

Staff had been recruited safely and had received a detailed induction into the service. According to the available training matrix, staff training was not up to date. Staff we spoke with were knowledgeable and were well supported by the registered manager and clinical lead.

Health and safety checks of the environment and equipment were in place although due to the handover of providers, some certificates in relation to the checks on slings were missing. The environment was due for a full refurbishment by the provider who was in the process of drawing up a plan for the required work.

People told us they liked the food and were offered choice of food options. Records were not always completed to show people were being supported to drink.

The home had referred people who had restrictions on their liberty to the relevant authorities. 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 and their relatives spoke highly of staff at the service who they described as caring and compassionate. Staff protected people’s privacy, dignity and helped them to be independent.

People were encouraged to participate in a range of different activities and spoke highly of the new activities coordinator and they had been involved in the recruitment process. Formal complaints were reviewed and responded to in line with company policy. Relatives told us the registered manager was responsive to informal complaints and improvements were made as a result.

The manager was working with professionals, stakeholders and the local community to improve the experience of people living at 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 requires improvement (published 9 November 2018). We have used the previous rating to inform our planning and decisions about the rating at this inspection. This is the second time the service has been rated as requires improvement. Since the last inspection the registered provider of the service has changed. The current provider is responsible for maintaining and improving the service, including addressing any issues from the last inspection.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive, and well-led sections of thereport. 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.