Background to this inspection
Updated
9 November 2018
This inspection commenced on 19 September 2018 and was unannounced, the inspection team consisted of two adult social care inspectors. One of the inspectors also visited the home again on 20 September 2018. This visit was announced and was to ensure the acting manager and the manager would be available to meet with us.
Prior to our inspection visit we reviewed the service’s inspection history, current registration status and other notifications the registered person is required to tell us about. Notifications are when registered providers send us information about certain changes, events or incidents that occur within the service. We contacted commissioners of the service, safeguarding and Healthwatch to ascertain whether they held any information about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. This information was used to assist with the planning of our inspection and inform our judgements about the service.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This information was used to help inform our inspection.
We used a number of different methods to help us understand the experiences of people who lived in the home. We spent time in the lounge and dining room areas observing the care and support people received. We spoke with four people who were living in the home and a visiting relative who was also a registered volunteer with Kenmore. We also spoke with the acting manager, manager, deputy manager and seven other staff which included a nurse, support workers an ancillary worker and two staff whose role was to facilitate the volunteers and activities. We reviewed five staff recruitment files and three people’s care plans. We looked also looked at some people’s medication administration records and a variety of documents which related to the management and governance of the home. Following the inspection, we spoke with four relatives of people who lived at the home, on the telephone.
Updated
9 November 2018
The inspection of Kenmore took place on 19 and 22 September 2018. We previously inspected the service in January 2018, at that time we found the registered provider was not meeting the regulations relating to consent, safe care and treatment, staffing, fit and proper persons employed and good governance. We rated them as inadequate and placed the home in special measures. The purpose of this inspection was to see if significant improvements had been made and to review the quality of the service currently being provided for people.
Kenmore is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Kenmore is registered to provide nursing and residential care for up to 26 people. At the time of the inspection 16 people were living at the home.
At the time of the inspection the home did not have a registered manager in place. The registered manager had left the organisation in March 2018, an acting manager had been in post since then. A new manager had been recruited, they had commenced employment on 17 September 2018, they had not yet commenced their application to register with the Care Quality Commission. 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 told us they felt safe. Risk assessments were in place and people received appropriate care and support where a risk was identified. Many of the previous concerns regarding medicines had been addressed although further work was required to ensure records provided sufficient detail.
Previous concerns regarding the risk of Legionella had been addressed. Equipment was serviced and maintained. Work was still to be done to meet the recommendations of a recent fire risk assessment.
Improvements had been made to staff recruitment. Staff efficiency had been improved by the introduction of walkie talkies.
New staff received an induction when they commenced employment. Most staff were up to date with their training requirements. Although some topics were listed as being ‘one off’, this meant staff did not receive refresher training in that subject. Staff were now being supported through regular supervision.
People spoke positively about the meals at Kenmore. Staff supported people to eat and drink, patiently and with discretion. We identified one person who had recently lost weight, however, their records had not been updated to reflect this.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, records did not always evidence the requirements of the Mental Capacity Act 2005 had been consistently met. We have made a recommendation about meeting the requirements of Mental Capacity Act.
People and relatives told us staff were caring and kind. Staff treated people with kindness, respect and compassion. People told us staff respected their choices and staff encouraged people to retain their independence and life skills.
Staff and a number of volunteers supported people to engage in a range of activities both in the home and in the community.
Peoples care records had been updated and reviewed to ensure they were person centred and reflective of their care and support needs. Although no one at the home was receiving palliative care, the home was due to re-commence its work towards achieving accreditation for end of life care
Many of the issues raised at our previous inspection about a lack of effective governance had been addressed. The acting manager had ensured the registered providers programme of audits was implemented. These helped track the progress of the service in addressing the failing identified at our previous inspection. The acting manager had ensured regular meetings were held with staff, residents and relatives, improving communication between people, relatives, staff and management. Feedback about the acting managers conduct and approach was consistently positive.
The service is no longer in Special Measures. This is the first time the service has been rated Requires Improvement.