Poplars Care Centre

Poplars Care Centre is a residential care home providing personal and nursing care to 45 people aged 65 and over, some of whom were living with dementia at the time of the inspection. The service can support up to 71 people, in two separate wings of the service.

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

Care records did not always contain the relevant information to keep people safe and reduce the risk of harm. Care records had been reviewed and audited on a regular basis however, the shortfalls had not been identified or rectified during these quality checks.

Staff had been trained and understood how to keep people safe from potential abuse. People spoke fondly of the staff supporting them. Observations showed people were treated with kindness by staff who understood the importance of protecting their privacy and dignity.

There were enough nurses and care staff to meet people’s needs. Medicines were managed safely and administered by nurses that had been trained and had their competency assessed.

Potential risk posed by the environment had been assessed with systems in place to reduce the risk. For example, regular checks of the fire alarm system and equipment used to support people to move were made.

Staff worked in partnership with external healthcare professionals to ensure people remained as healthy as possible.

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.

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.

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 22 April 2020).

Why we inspected

The inspection was prompted in part due to concerns received about discrepancies and inconsistencies within people’s care records. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe 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.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Poplars Care Centre 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified a breach in relation to failings within the care records at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Poplars Care Centre is a care home providing personal and nursing care to 56 people aged 65 and over, some of whom were living with dementia at the time of the inspection. The service can support up to 71 people, in two separate wings of the service.

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

Staff were kind and caring in their approach to people. However, staff were observed entering people’s bedrooms without knocking first. People said staff protected their privacy and dignity whilst delivering personal care.

The complaints procedure was not in an accessible format and people did not consistently know how to make a complaint or raise a concern. However, this was rectified shortly after the inspection.

People’s needs were assessed before they moved into the service to ensure the care team could meet their needs. People were supported to maintain their health with the nursing team working alongside external health professionals. Potential risks posed to people had been assessed and mitigated.

People received the care and support they wanted and needed. Care plans and risk assessments had been reviewed and updated.

Staffing levels were based on people’s needs. There were enough care staff and nurses to meet people’s needs, call bells were answered promptly. Staff continued to be recruited safely.

People enjoyed the food and were offered a nutritionally balanced diet, with a variety of snacks and drinks. People’s nutrition and hydration needs had been assessed and staff followed guidance to support people with their nutrition. Referrals were made promptly if people required additional support.

Medicines were stored and administered safely by registered nurses. Staff were trained to meet people’s needs and registered nurses were supported to keep their registration with the Nursing and Midwifery Council (NMC). Nurses and care staff received continuous support and supervision from the management team.

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’s, relatives and staff’s feedback was sought and acted on. People were supported to access a range of activities within the service during the afternoon. The management team completed a range of audits to monitor and improve the quality of 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 Requires Improvement (published 6 March 2019) and there was a breach of regulation 12. 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 the provider was no longer in breach of regulation 12.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Poplars Care Centre is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Poplars Care Centre is registered to provide accommodation and personal care for a maximum of 71 frail and elderly people, some of which were living with dementia. At the time of our inspection there were 61 people living at the service. The service is a large extended property and people's accommodation is provided over two floors with a lift available to support people to the upper floor.

There was a registered manager at the service. 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 did not always receive their medicines safely. Medicines were not always being stored in line with manufacturers guidelines. People were not always receiving their medicine as prescribed. The registered manager did not always have the necessary oversight of the service to identify some of the concerns we found during our inspection.

People were protected from the risk of abuse. Staff were trained in how to identify abuse and knew how to report it. Risks to people and the environment were assessed, recorded and staff took steps to reduce them.

People had their care and support delivered in line with current legislation and best practice guidance. Staff had the skills and experience to provide effective care and support. Newly recruited staff received an induction which included training courses and gaining experience by shadowing more other staff. Established staff received refresher training that was built around those using the service.

There were enough staff to meet people’s needs. New staff were recruited safely. People were protected by the prevention and control of infection. The registered manager took steps to learn from incidents, accidents and when things went wrong. They used information to help prevent future accidents.

People's nutrition and hydration needs were being met. People were involved in developing menus. Staff sought and followed guidance from health professionals if people had health conditions. People had access to health care and treatment. People's needs were met by the design and adaptation of the premises. People could decorate and furnish their rooms as they wished. Staff were knowledgeable about the Mental Capacity Act (MCA) 2005, and worked in line with its principles.

People felt cared for by staff. They were treated with kindness and compassion by staff who knew them well. Staff used different ways to communicate with people. People were supported to express their views and be actively involved in making decisions about their care. People were treated with dignity and had their privacy respected.

Support was provided to people in a personalised way. Each person had their own care plan which had been reviewed taking into account their preferences and views. People were supported to take part in activities of their choosing. People said they knew how to make a complaint, and would do so if the need arose. Complaints and concerns were managed in accordance with the registered provider's policy. People were supported at the end of their lives to have a dignified death. Their preferences and wishes were gathered and staff worked closely with health professionals.

The culture at the service was honest and transparent. Staff said they felt proud to work at the organisation. The staff had oversight of the daily culture in the service, which included the attitudes and behaviour of staff. People, their families and staff were encouraged to be engaged and involved in the service. There were links with the local community.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This is the first time the service has been rated Requires Improvement.

Poplars Care Centre is a care home providing accommodation for up to 71 older people who require nursing and personal care. The home is located in a residential area in Maidstone. At the time of the inspection 65 people lived at the service.

There was a registered manager employed at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The registered manager was not available on the day of the inspection, and the operations manager and deputy manager assisted with the inspection process.

The registered manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Management understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

People were protected against the risk of abuse. Staff had been trained in how to protect people, and they knew the action to take in the event of any suspicion of abuse towards people. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the registered manager or outside agencies for example Social Services if this was needed.

People’s needs varied, some people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. Therefore we observed their care and staff interactions. People demonstrated that they were happy by showing warmth to management and staff who were supporting them. For example by nodding their head or giving a smile. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Nursing staff carried out on-going checks for people’s health needs, and contacted other health professionals for support and advice.

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified some needs but were not always specific in meeting people’s individual needs, and showing how risks could be minimised.

Medicines were stored, administered and disposed of safely. There were policies and a procedure in place for the safe administration of medicines. People had access to GPs and other health care professionals. Prompt referrals were made for access to specialist health care professionals.

People were provided with diet that met their needs and wishes. Menus offered variety and choice. People said they liked the home cooked food. Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served.

People were given individual support to take part in their preferred hobbies and interests, and a range of activities were being provided by the activities co-ordinator and staff.

People were aware of the complaints procedure and they knew who to talk to if they were worried or concerned about anything. Relatives said that they knew who to complain to if they had any concerns and provided positive feedback on the service as a whole.

There were systems in place to obtain people’s views about the service. These included formal and informal meetings; events; and daily contact with the registered manager and staff.

The providers and registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained. The providers and registered manager understood the requirements of their registration with the CQC.

We found that people spoke highly of the care they received at Poplars Care Centre. People's comments included: 'I am very happy here. They look after me very well. I just ring the bell if I want anything.' 'It is very nice here, the staff are very good.' And: 'All the staff are wonderful. I cannot speak highly enough of them. And it is always spotlessly clean. I love it here.'

We found that people's individual wishes were respected, and people were treated with respect.

People's health care needs were met through the nursing and care staff, and through visits from other health professionals.

People said they felt safe in the home, and there were systems in place for reporting any concerns.

The home had reliable systems in place for managing people's medicines correctly.

The company had robust recruitment procedures in place, which ensured that staff were suitable people to work with vulnerable adults.

The home had on-going monitoring systems to check the quality of the service being given. People's views were listened to and were taken into account.

We carried out this visit to inspect medication processes, and assess compliance with this outcome.

The manager was not available at the time of our visit, and the deputy manager assisted us with providing access to clinical rooms and relevant documentation.

We found that the home had carried out significant improvements to provide safer storage and administration of medicines.

We found that the home had a pleasant and friendly atmosphere, and staff were welcoming to visitors. People said that the care was 'very good' and that they were confident in the staff who were caring for them.

Two relatives said that the care was 'brilliant', and people receiving care said that 'They are very good to us' and 'Yes, they look after us very well.'

Most of the people that we spoke to were happy with the food provided. We found that monthly checks were carried out to check people's weights and nutritional management.

We found that medication was given reliably. We identified concerns in regards to storage of some medicines, and some unclear recording processes.

The home provided a suitable range of equipment for caring for people, and this was satisfactorily maintained.

We found that the home provided all of the mandatory training for staff, and ensured this was kept up to date.

We saw that records were stored securely, and were well maintained and appropriately completed.