Archived: Kilsby House Residential Home

Kilsby House Residential Home is a residential care home providing personal care to older people living with dementia. At the time of the inspection 24 people were using the service. The service can support up to 39 people.

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

Systems and processes were not robust enough to identify and monitor the issues we found during the inspection.

Risk assessments were not always completed with the strategies needed to mitigate the known risks.

Records of care tasks were not always completed fully. For example, we found gap in the recording of pressure damage and food and fluid charts.

On the first day of inspection we found concerns with infection control and the management of COVID-19, however by the second day of inspection the provider had made improvements.

People were supported by enough staff who knew them well and had been safety recruited.

Staff and relatives knew the registered manager and felt comfortable raising any concerns with them.

The registered manager and staff were open and transparent throughout the inspection. The registered manager implemented changes immediately after inspection. The provider needs to ensure these changes are embedded into 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

The last rating for this service was good (published 12 April 2019)

Why we inspected

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 received concerns in relation to infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to infection control, safe care and oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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.

People’s experience of using this service:

¿ People told us they felt safe at the service and supported by staff who were trained in safeguarding procedures.

¿ Effective safeguarding systems and policies in place.

¿ Potential risks to people’s health and welfare were assessed, effectively monitored.

¿ Safe staff recruitment practices were followed. Staffing arrangements were sufficient to meet the needs of people using the service.

¿ Medicines were safely managed.

¿ Staff received appropriate training and effective supervision to perform their roles.

¿ Mental capacity assessments were completed, and any best interests’ decisions were made with the involvement of people’s representatives and relevant health care professionals.

¿ A variety of nutritious meals were provided, and people were supported to eat, and drink sufficient amounts.

¿ People’s care was personalised to meet their individual needs. Their diversity, cultural and religious needs were promoted and respected.

¿ People’s privacy and dignity was maintained.

¿ Positive caring relationships had been developed between people and the staff team.

¿ People and their relatives were involved in all aspects of care planning where appropriate.

¿ People’s end of life wishes were respected.

¿ People had opportunities to take part in meaningful activities that were of interest to them.

¿ The provider operated an open and transparent culture.

¿ People, relatives and staff were encouraged to ‘speak up’ if they had any concerns.

¿ Systems were in place for people to raise any concerns or complaints.

¿ Independent advocacy support was available, if required.

¿ Systems were in place for people, their relatives and staff to provide feedback and influence service development.

¿ Robust quality monitoring systems and processes were followed. Action was taken where any areas for improvement were identified and lessons learnt from incidents was shared with the staff.

¿ The provider, registered manager and staff team worked well with professionals and external organisations and they effectively used good practice guidance to enhance people’s quality of life.

Rating at last inspection: Good (report published 14 March 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Kilsby House provides accommodation and personal care for up to 39 people some of whom may be living with dementia. There were 30 people living at the home during this inspection

There was a registered manager in post. 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 were supported by sufficient numbers of staff that were experienced and supported to carry out their roles to meet the assessed needs of people living at the home. Staff had received training in key areas that enabled them to understand and meet people’s care needs. Recruitment procedures were followed and people received care from staff that were suitable for their role. People were protected from the risk of harm because staff were confident in recognising and reporting concerns to the registered manager or appropriate external agencies..

People had detailed individual plans of care in place to guide staff in delivering their care and support. People’s needs were continually monitored and reviewed to ensure they received appropriate care and support. People and their representatives had been involved in developing their plans of care which meant that people received consistent and personalised support.

People’s health and well-being was monitored by staff and they were supported to access relevant health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to help maintain their health and well-being.

Staff took time to get to know people and ensured that people’s care was tailored to their individual needs. People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored by the audits regularly carried out by the registered manager and by the provider. There were effective safeguarding procedures in place to protect people from the risk of harm.

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

When we inspected on 8 May 2014 we found that the infection prevention and control practices of staff were inadequate. This had posed a risk to people who used the service. The provider sent us an action plan setting out what needed to be done to put this right. When we inspected again on 25 July 2014 we found that the provider had made, and sustained, the necessary improvements required. We saw that people's health was appropriately protected by the measures taken to prevent and control infection within the home.

We found that the home had been appropriately maintained. We saw that people were cared for in a homely environment that was kept clean and hygienic. This meant that people were supported and cared for in a safe environment.

Staff demonstrated an understanding of the support required to enable people with dementia to make choices about their daily lives and their care. The registered manager had assessed each person to ensure the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) were considered in the planning of people's care.

People received regular assessments of their needs in order to identify any areas of risk in delivering their care. Staff regularly reviewed risk assessments to ensure any changes to people's health and well-being were identified promptly. People's care records contained accurate information to ensure staff understood how to deliver care.

Is the service effective?

Effective systems were in place to monitor the management of the service. We saw that people's care plans and risk assessments were regularly reviewed and updated as and when their needs changed. Staff were able to tell us about people's individual needs and how they supported them on a daily basis as well as long term. This meant that because staff had a good knowledge of each person's care needs and preferences they were able to provide effective care.

Is the service caring?

People were supported by kind and attentive staff. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that people's health was closely monitored and appropriate action was taken in seeking the advice, guidance, and appropriate attention of health and social care professionals.

Is the service well-led?

We saw that the manager had immediately acted upon what we found when we inspected on 8 May 2014. We found that since then the manager had provided staff with the support and managerial guidance they needed to sustain the improvements that were made. The staff we spoke with said the manager was very approachable and very conscientious.

We saw that the registered manager had a good understanding people's needs and how to support and care for them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The registered manager had assessed each person to ensure the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) were considered in the planning of people's care. Staff demonstrated an understanding of the support required to enable people with dementia to make choices about their daily lives and their care. People received regular assessments of their needs in order to identify any areas of risk in delivering their care. Staff regularly reviewed risk assessments to ensure any changes to people's health and well-being were identified promptly. However, people's care records did not always contain accurate information to ensure staff understood how to deliver care. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

The infection prevention and control practices of staff were not robust and presented a risk to people who used the service. There were no hand decontamination materials such as liquid hand soap available in people's bedrooms to enable staff to wash their hands following personal care. Equipment such as people's mattresses had not always been appropriately cleaned and people's bedrooms were not subject to a full daily clean. This put people at risk of contracting a heath care associated infection. This meant there was a breach of the Health and Social Care Act regulations. Enforcement action has been set and the provider is required to take action to improve.

Is the service effective?

People's health and care needs were assessed with them, and they and their family members were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. Relatives of people who used services and a visiting health professional told us that people received good care which met people's individual needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us that they were happy living at Kilsby House. One person said 'The staff are very nice and all look to make sure we are comfortable.' Another person said 'I've been to the hairdressers today and its pleasant living here, all the staff are pleasant and kind.' People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People told us that they had been on a recent outing to the garden centre and had enjoyed themselves. We observed people sitting in the living room and saw that there were enjoying the company of one another. We also observed staff and people playing a game of bingo, which we saw the people enjoyed. Staff had responded appropriately to a range of medical needs and we saw that medical professionals such as the G.P, district nurse and dietician were regularly involved in people's care.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff stated that the registered manager expected high standards of care at the home and would act on any concerns raised immediately. Staff also told us that the registered manager had a good understanding of the needs of people who used services and we saw they reviewed people's plans of care to ensure they were well looked after.

The service had a quality assurance system, and this included gaining the regular feedback of people who used services. We observed that staff had enabled people with a diagnosis of dementia to feedback about the quality of services provided. However, audits relating to the cleanliness of bedrooms were not sufficiently detailed to identify any shortfalls relating to infection, prevention and control. Staff were not always clear about their roles and responsibilities in regards to infection control. This meant that serious risks relating to infection prevention and control had been undetected and these presented a risk to people who used services. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must report how they intend to improve the service.

We spoke with two people who used the service who told us that they were happy living at the home. We observed that people who used the service were relaxed and well cared for.

We spoke with four relatives of people who used the service who were all very happy with the care that their relative received and that they were safe. One relative told us 'We are involved in the care planning and we are invited to meetings'. Another relative told us 'we have no concerns, we are so delighted with the care here'. They went on to tell us 'there is always such a calm atmosphere and the staff are always happy, they've always got time to talk to us'.

We spoke with three staff members who all told us that they enjoyed their roles and that they felt that people who used the service received a good standard of care.

We looked at care plans and found that people's needs had been assessed and a plan of care put in place to ensure that their needs were being met. We found that there were appropriate arrangements in place to manage medicines and that there was an adequate amount of equipment available to assist people with their mobility. We found that peoples' relatives were made aware of the complaints procedure and that they felt able to raise any concerns. We found that there were enough staff on duty to meet people's needs.

We had concerns that the records that were kept by the provider had not always been updated to reflect people's current needs.