Archived: Kemp Lodge

Kemp Lodge provides support for people who have an acquired brain injury. It is owned by Voyage Care. The home Lodge can accommodate up to seven people in one adapted building, at the time of our inspection seven people were living at the home.

Kemp Lodge 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.

The home had a registered manager. 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.

During our previous inspection in April 2017 there were breaches of Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating of the service was ‘requires improvement’. This is because people using the service and those lawfully acting on their behalf, had not always given consent before care or treatment was provided. The provider did not seek and act on feedback from people using the service, those acting on their behalf, staff and other stakeholders. And, the provider did not maintain accurate, complete and detailed records in respect of each person using the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions. Is the service safe? Is the service effective. Is the service responsive? and; Is the service well-led? To at least good.

At this inspection we found that the service was ‘good’ and was no longer in breach of regulations. This was because appropriate procedures had been followed to ensure that the administration of covert medication was appropriate, legal and in the person’s best interests. Also, the service was now working within the principles of the MCA and people’s consent to their care was sought.

At this inspection we looked at the care files for four people. The information contained was up to date, detailed and thorough. Important information to and for a person was clear and highlighted at the front of the care file. People told us that the support they received met their needs. One person said, “I wish to go home. These guys are helping me to get ready for this.”

We also saw that feedback from people, their relatives and staff had been obtained by a stakeholder questionnaire. There were also less formal plans to engage with people; we saw that there was an upcoming friends and family BBQ planned. We also saw that there had been regular ‘house meetings’ were feedback was sought from people living at Kemp Lodge.

People living at the home told us that they felt safe and secure. One person when referring to a member of staff said, “He’s a good friend of mine. He keeps his eye on us. I like it here, I wouldn’t; want to move.” Another person told us, “I feel quite safe here. I like the people here.” There were enough staff at the home to meet people’s needs safely. They had been safely recruited and appropriately trained in safeguarding vulnerable adults. Steps had been taken to ensure that the home’s environment was safe.

People living at the home praised the staff and how they cared for them. People told us that they had got on very well with the staff and had found them friendly. Staff told us that they enjoyed their roles and received appropriate training and support to be effective. People at the home were listened to and were treated with dignity and respect.

People’s needs and choices were assessed as part of the care planning process when arriving at the home. Their support was delivered in line with these by staff who had the skills and knowledge to do so effectively.

We saw that people were supported in a range of meaningful activities both inside the home and in their community. Some of these activities were used to build relationships with people and to build up their confidence.

There was a culture of learning from and with people at the service and using this information to improve the support people receive. There was a focus on enablement and reducing people’s support so if possible, they were able to move into their own homes.

The registered manager and deputy manager were friendly and it was clear that they had positive relationships with the people at the home. The registered manager conducted a series of quality audits on different areas of the home and the quality of the service provided for people.

The home had a registered manager, however at the time of the inspection the registered manager was not working in the home. 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.

We last inspected Kemp Lodge on 4 and 8 December 2015 when we found that the home was providing an overall good service but improvements were needed to the management of people’s medication. Since that inspection we have received information of concern about the service and so this inspection was brought forward.

During the inspection we found breaches of Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because: people using the service, and those lawfully acting on their behalf, had not always given consent before any care or treatment was provided and: the provider did not seek and act on feedback from people using the service, those acting on their behalf, staff and other stakeholders.

Most people told us that they thought Kemp Lodge was a safe place to live, however we heard some concerns about whether there were enough experienced staff to ensure that people were kept safe and that their support needs were met.

Improvements had been made to the arrangements for the storage of people’s medicines, however there was scope for further improvement.

People living at the home did not receive a varied and nutritious diet and the home’s kitchen had a poor food hygiene rating.

A system for staff supervision and appraisal was in place but had not been kept up to date.

People’s capacity to make decisions was assessed and appropriate Deprivation of Liberty Safeguards were in place, however we did not see evidence that people living at the home and/or their families had always been involved in making important decisions about their care and support and this was confirmed by a relative we spoke with. There were no records of complaints that had been made.

Care records were not always sufficiently detailed, accurate or up to date.

Systems were in place for checking the quality of the service provided but these had not always been effective.

The house was well maintained with systems in place for checking the safety of the building. Work was taking place to improve the environment.

Systems and training were in place to help staff identify and deal with any allegations of abuse and appropriate notifications had been made.

New staff were recruited safely and a programme of staff training was up to date.

People received support to access health professionals as and when needed.

Staff knew people’s individual needs, choices and communication methods and we saw that staff treated people with kindness and respect.

The provider had taken, and was continuing to take, positive action to address concerns raised during recent months.

Is it safe?

We saw evidence that staff completed their safeguarding training annually, staff also confirmed this. We saw the provider regularly reviewed risk assessments to maintain people's safety.

Deprivation of Liberty Safeguards' (or DOLS) were introduced to protect individuals from the unlawful deprivation of their liberty as a part of the Mental Health Act 2005. Three people were subject to standard authorisations to restrict their liberty. We saw the provider maintained all the correct paperwork for every person who required a deprivation of liberty as well as a capacity assessment. Records also showed whenever possible the manager supported individuals to be involved in this process.

Documentation around people's support plan reviews showed that people who used the service, health and social care professionals and where appropriate relatives were involved in the review process. This demonstrated that people's rights were respected and promoted in a safe environment which protected them from harm.

Is it effective?

We saw the manager conducted reviews with people who used the service. This looked at whether people were satisfied with the care and support offered and the range of activities available to them.

Care records showed that people who used the service were supported to access health and social care services. Records also showed people's relatives/representatives were either directly involved or kept informed about outcomes of consultations/meetings with health or social care professionals.

Is it caring?

Staff were observed being supportive and attentive to people's needs and promoting their independence. We spoke with two people who used the service. They commented that the staff team were always 'supportive' and 'kind'.

Records showed that the staff team supported people who used the service to be fully involved in the reviews of the support and care provided.

Is it responsive?

We saw the service organised a wide range of activities as a result of people's personal preferences and individual goals. The two people spoken with told us they had activity boards to support them to structure their days and they said the staff team promoted their independence. This meant the provider listened and took account of peoples' wishes and preferences and responded appropriately.

The training record for the staff team showed the provider offered staff service specific training to enable them to provide appropriate and safe care to people with complex needs.

Is it well led?

We saw the provider had systems in place to monitor the quality and safety of the service provided. The provider sent out annual feedback questionnaires to people who used the service, visiting professionals and relatives. Those returned contained positive comments about the service provided.

The provider gave people the opportunity to review whether they were happy with the service provided and supported them to access independent advocacy services if they felt they needed this support.

We asked people who used the service and staff about the manager and their ability to deal with concerns. They all felt the manager dealt with any issues very promptly and everyone we spoke with gave positive comments about their management style for example:

'He is approachable and very clear about how we should support people'.

'He is very confident in how he manages and that makes me feel confident'.

'He is all about the people we support'.

"He is on my side and makes sure people listen to me".

The provider also took account of complaints and comments to improve the service.