Archived: Ernest Kleinwort Court

Updated 23 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 7 and 9 March 2017 and was unannounced. The inspection was carried out by four inspectors.

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. We reviewed the information we held about the service, including previous inspection reports. We contacted the local authority to obtain their views about the care provided. We considered the information which had been shared with us by the local authority and other people, looked at notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

During the inspection we reviewed the records of the service. These included staff recruitment files, training and supervision records, medicine records, complaint records, accidents and incidents, quality audits and policies and procedures along with information in regards to the upkeep of the premises.

We also looked at nine care plans and risk assessments along with other relevant documentation to support our findings. This included 'pathway tracking' people living at the service. This is when we looked at their care documentation in depth and obtained views on their life at the service. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

During the inspection, we spoke with seven people who lived at the service, one visiting relative, the acting manager, divisional manager, two assistant managers, cook, activity coordinator and seven care staff. We also spoke with seven relatives by telephone to gain their views of the care provided to their family members. We spent time observing the care and support that people received in the lounges and communal areas of the home during the morning, at lunchtime and during the afternoon. We also observed medicines being administered to people.

The last inspection of the home was 5 and 6 October 2016 where we found areas of practice that needed to improve. The home was rated ‘Requires Improvement’.

Updated 23 May 2018

The inspection took place on 7 and 9 March 2018, the first day was unannounced and the second day was announced.

Ernest Kleinwort Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can provide accommodation and personal care for up to 33 people who require support with their personal care. The service specialises in supporting younger adults with physical disabilities. There were 31 people living at the service at the time of our 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 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. On the day of the inspection, the registered manager was not present and the service was being overseen by an acting manager.

The inspection was prompted in part by notification of an incident following which a person using the service was subject to serious harm. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However the information shared with CQC about the incident indicated potential concerns about the management of weight loss. This inspection examined those risks.

Risks to people's safety had not always been adequately assessed, monitored and minimised. This included risks associated with nutrition, choking, catheter care and skin breakdown. Care staff did not consistently have oversight of people's air mattresses settings and some air mattresses were set at the incorrect setting which placed people at risk of their skin breaking down.

People were not supported in a consistent manner to live healthier lives. Poor joint working meant people were also not supported in an effective manner to receive care and support that promoted their wellbeing. Poor documentation meant the provider could also not provide assurances that people had been supported to access healthcare services.

Documentation was not always fit for purpose or accurate. Discrepancies and gaps in recording had not consistently been identified by the provider as a shortfall and consequently the provider was unable to demonstrate if people received the care required or whether it was a failure to document the care provided.

People’s care needs were not assessed in a holistic manner and staff members raised concerns that people were not always supported to meet their social and psychological needs. One staff member told us, “Activities are not strong.” Whilst end of life care plans were in place these lacked guidance and detail. This is an area of practice that needs improvement.

The principles of the Mental Capacity Act (MCA) 2005 were not consistently applied in practice. A range of restrictive practice was in place, but the care planning process failed to identify if care could be delivered in a least restrictive manner.

Systems to assess and monitor the service were in place but these were not sufficiently robust as they had not ensured a delivery of consistent high care across the service or pro-actively identified all the issues we found during the inspection.

People spoke highly of the food provided. One person told us, “It’s like going to the Savoy every day.” However, risks to people with complex care needs had not been identified or managed in relation to their eating and drinking. Risks associated with weight loss were not managed effectively.

The management of medicines was not consistently safe. Staff members felt there was blame and shame culture. Staff members felt devalued. One staff member told us, “We need strong management.” People were not consistently protected by the prevention and control of infection. A range of training was available for staff, however, staff felt training did not always provide them with the required skills and abilities. We have identified this as an area of practice that needs improvement.

People’s right to privacy was respected. Staff knew the people they were caring for very well. It was clear that permanent members of staff had built positive rapports with people. Recruitment checks were carried out to ensure suitable staff were employed to work at the service.

People's individual ability to evacuate the service has been assessed and evacuation plans were in place. Safeguarding policies and procedures were available for staff to access and people told us they felt safe at the service. A range of group activities took place and the provider employed a dedicated activity coordinator.

We found a number of breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the registered providers to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.