We carried out a review of the data available to us about Keele House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Keele House, you can give feedback on this service.
Keele House is a residential care home which provides personal care for up to 31 people. The service provides support to older people, people living with dementia and a person with a learning disability. At the time of our inspection there were 25 people using the service.
People’s experience of using this service and what we found
People told us they felt safe at Keele House and there was a homely atmosphere. One person told us, “ They are very, very good. They look after me. They are exceptional”.
The provider had taken effective action since the last inspection to improve the quality of care people received. Effective checks and audits were now completed regularly and any shortfalls were addressed. A registered manager had been appointed and they led the staff team to provide a good standard of care. Staff were motivated and felt appreciated. People, their relatives and staff were asked for their feedback on the service and this was acted on. Relationships between the staff and health care professionals had improved.
Risks to people were assessed and care was planned to keep people safe while supporting them to remain as independent as possible. Medicines were managed safely and medicines records had improved. When accidents or incidents occurred, action was taken to reduce the risk of them happening again. There were enough staff, who had been recruited safely to meet people’s needs. Staff followed safe infection control processes.
People were protected from the risks of harm and abuse. Staff knew how to identify and share any concerns they had. Concerns raised had been listened to and acted on. 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 expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
Staff knew people well and had taken time to get to know them. People’s wishes and preferences were respected. Staff reassured people when they were anxious. People had privacy and were supported to remain independent.
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 9/11/21).
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 improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We received information from the local authority that the service had improved and an increase in the provider’s rating would improve capacity in the local market. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.
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.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Keele House is a residential care home providing personal care to 21 older people at the time of the inspection. Keele House accommodates up to 31 people in one adapted building.
People’s experience of using this service and what we found
People and their relatives told us they were happy with the care provided at Keele House. Their comments included, “I am looked after very well indeed, they are nice people and it is good food” and “The staff are excellent, reliable and very approachable”.
The provider’s oversight of the service had improved since our last inspection and a new manager had been appointed. However, despite these improvements further action was required to ensure people were always safe. Medicines were not always stored and managed safely, and this left people at risk of harm. People’s care plans were not sufficiently detailed and did not provide staff with all the information they needed to provide safe care. However, we observed staff knew people well and provided the care and support they needed. Checks and audits were not always robust and the shortfalls we found had not been identified.
There were enough staff with the right skills and experience to meet people’s needs. Staff training, support and development had improved. The provider had improved the culture and staff now felt supported and empowered to share their views. When things went wrong, investigations were completed, and lessons were learnt. Staff no longer felt they were blamed for any mistakes and felt part of the solution.
The relationship between the staff and local healthcare professionals had improved. Staff acted promptly when people’s health changed and followed guidance provided by health care professionals. Meals were prepared to meet people’s needs and people told us they enjoyed the food at the service.
The service was clean and staff followed national guidance to manage the risk of the spread of infections such as COVID 19. Relatives told us, “It is always very clean and fresh smelling” and “We are always welcome when we visit and without fail have a COVID-19 lateral flow test”. The building had been adapted to meet people’s needs.
People and their relatives told us people were safe at Keele House. Staff knew how to identify any safeguarding risks and shared any concerns with the provider and manager. One relative told us, “I know for a fact that [my relative] feels safe and comfortable living there”.
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, their relatives and staff had been asked for their views of the service. These had been acted on to improve and develop the service. When complaints were received, the provider had offered an apology and acted to resolve the issues.
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 27 April 2021) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.
Why we inspected
We received concerns in relation to leadership and identifying changes in people’s health. As a result, we undertook a focused inspection to review the key questions of safe, effective 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.
You can see what action we have asked the provider to take at the end of this full report.
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 also 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.
Keele House is a residential care home providing personal care to 21 older people at the time of the inspection. Keele House accommodates up to 31 people in one adapted building.
People’s experience of using this service and what we found
People and their relatives told us they felt safe at Keele House. However, we found that people’s medicines were not always managed safely by skilled staff. Effective checks and audits were not completed to identify any shortfalls at the service.
The provider had made some improvements at the service since our last inspection however further improvements were required. The registered manager had not developed a culture in the service which reflected the provider’s aim for a supportive and inclusive service were everyone’s views and opinions were valued. Staff did not always feel supported by the registered manager and some concerns they had raised had not been acted on.
People, their relatives and healthcare professionals were now fully involved in planning people’s care, including their end of life care. People’s care reflected their needs and preferences. Staff worked with health care professionals to keep people as well as possible. Staff knew how to identify safeguarding risks and any concerns had been discussed with the local authority safeguarding team. Lessons had been learnt when things had gone wrong or complaints had been received. People’s care or other processes had been changed to reduce the risk of things going wrong again.
People were supported to continue to do things they enjoyed. Information was available to people in ways they understood. 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 told us they enjoyed the food at Keele House and meals were prepared to reflect their needs and preferences.
Risks related to people’s care and the building were managed. The garden was now safe and accessible to people who enjoyed spending time there. There were enough staff to provide the care and support people needed and staff had been recruited safely.
The provider had followed all government guidelines during the COVID-19 pandemic and we were assured infection control risks were managed. People were supported to receive visitors in a safe way and regular COVID-19 tests were completed.
People, their relatives and staff had been asked for their views of the service and changes had been made following their feedback. The registered manager was working with health care professionals to ensure effective and open communication about people’s health care needs.
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 19 October 2019). 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 improvements had been made in some areas and the provider was no longer in breach of three regulations. Enough improvement had not been made in other areas and the provider was still in breach of one regulation. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 5 and 6 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective, Responsive and Well-led which contain those requirements.
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.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. 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 Keele House on our website at www.cqc.org.uk.
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 also request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.
Keele House is a residential care home providing personal care to 26 older people at the time of the inspection. The service can support up to 31 people. Keele House accommodates people in an adapted building.
People’s experience of using this service and what we found
Changes to the leadership arrangements before our inspection had unsettled the service. The provider had recognised this and was acting to support staff and make improvements. They had implemented a new quality assurance system but this was not being fully completed and had not identified some of the shortfalls we found. People’s views and suggestions had not been consistently used to develop and improve the service.
People did not always feel safe at the service because other people they lived with had behaviours which challenged. Staff followed guidelines to reduce the risks but people continued to feel unsafe at times.
People were not always protected from the risk of harm as staff were not fully aware of the actions required to support people to remain safe in the event of a fire. Some people were at risk of losing weight because most foods had not been fortified with extra calories. Other risks to people had been assessed and mitigated. People told us they liked the food at the service.
People were not always supported to remain as well as possible. They did not have access to regular dental checks. On one occasion the recommendation of a community nurse had not been followed. The advice of other health care professionals had been followed. People had not been asked about their end of life care preferences.
Most areas of the building and grounds were safe. The provider had identified a shed in the garden which posed a risk to people but had not arranged for this to be removed. People were protected from the risk of infection. People received their medicines safely but the date medicines were opened was not always recorded.
People did not always have privacy as some staff entered their room without obtaining permission first. People told us most staff treated them with kindness. Staff reassured people when they were anxious and supported them to continue to live their life in the way they preferred.
Some staff had not completed refresher training as required by the provider. This had not been challenged by the registered manager, who took action after our inspection to make sure staff completed the required training updates. There were enough staff to meet people’s needs. Staff had been recruited safely but clear processes had not been followed when staff had transferred from other services owned by the provider.
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 needs were assessed and their care was planned with them. However, people had not been supported to share their end of life care preferences with staff. Staff supported people to continue to be independent. People had enough to do each day but their suggestions to improve activities had not been acted on.
We have made a recommendation about the Accessible Information Standard.
Complaints and concerns people raised had been resolved.
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 10 August 2018). The service remains rated requires improvement.
At the last inspection we recognised that the provider had failed to display the latest Care Quality Commission rating for Keele House on their website. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to protecting people from the risk of harm, protecting people from the risk of abuse and a lack of effective checks and audits of the quality of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We carried out an unannounced comprehensive inspection of this service on 14 March 2017. Since that inspection we received concerns in relation to how people were supported when their health deteriorated and in relation to the handling of complaints. As a result, we undertook an unannounced focused inspection of Keele House on 06 July 2018. We inspected the service against two of the five questions we ask about services: Is the service responsive and is the service well-led. At this inspection the service was rated as requires improvement in responsive and well-led, therefore the overall rating for the service is now requires improvement. This report only covers our findings in relation to these two domains. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Keele House on our website at www.cqc.org.uk.
Keele House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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. Keele House is a large detached house in a quiet residential area of Ramsgate. It provides care and support for up to 31 older people some of whom are living with dementia. At the time of the inspection there were 27 people living at the service.
There was a registered manager working at the service. A registered manager is a person who has registered with CQC 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’s concerns and complaints were not consistently recorded in line with the provider’s policy. Informal complaints had not been consistently recorded. Formal complaints were investigated, responded to and recorded. Complaints were used as an opportunity to improve the service and learn lessons. The provider agreed this was an area for improvement.
Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance to the service but it was not displayed on their website.
People’s needs were assessed and monitored. Each person had a care plan which gave staff guidance about their preferred routines.
People were encouraged and supported to keep their body and mind active with a variety of activities to choose from.
People’s choices and preferences for their end of life care were recorded to make sure staff could follow their wishes. Staff worked with health care professionals to promote joined-up care.
The registered manager had an open-door policy. They completed checks and audits regularly to monitor the safety and quality of the service.
Staff understood their roles and understood the provider’s whistle-blowing process. Staff told us they felt supported and valued. The staff team promoted individualised care.
Accidents and incident were monitored and lessons were learned when things went wrong to reduce the risk of it happening again.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider 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.
Keele House is a large detached house in a quiet residential area. It provides care and support for up to 31 older people some of whom are living with dementia. There were 28 people living at the service when we visited.
The service had a registered manager who had been at service for a number of years. 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. This was the first inspection since a change of provider in February 2016.
People told us they felt safe at the service. Staff recognised different types of abuse and knew who they would report any concerns to, they were confident that the registered manager would address any issues. Risks to people were identified, assessed and plans were put in place which gave staff the guidance needed to manage and minimise the risks. People’s medicines were managed safely and in the way they preferred.
The registered manager had completed audits to identify environmental risks. Fire drills were completed and people had a personal emergency evacuation plan (PEEP) in case of a fire. Additional audits had been completed to monitor the quality of care given to people and checks were carried out on the records completed by staff to make sure they were accurate and up to date.
There were enough staff to meet people’s needs and they were recruited safely. Staff told us they were well supported, they had regular one to one meetings with their line manager and had the training required to meet people’s needs. People, staff and relatives told us that the provider and registered manager were approachable and accessible. The provider and registered manager spent time with people on a regular basis, including people who chose to stay in their rooms. Everyone working at the service shared the same visions and values, which were to keep people safe, independent and provide quality care.
People were involved in developing and updating their care plans, the service had a new online system for care plans and recording the care people received. People’s care plans were person centred and showed what people could do for themselves and how they preferred to be supported. Staff knew people well, interactions between people and staff were affectionate and relaxed. Staff offered people reassurance and encouragement. People were laughing with staff throughout the day. People could have visitors whenever they liked and were supported to maintain relationships with family and friends.
There was a picture board in the dining room letting people know what activities were happening each day, some people said these could be more varied. The registered manager and provider agreed this was an area for development.
People had a choice of food and drinks each day. There was a menu board in the dining room with photographs of the meals on offer. People were encouraged to eat a balanced diet to stay healthy. People’s had a target for the amount of fluids they had each day to prevent dehydration. When people were at risk of choking speech and language professionals had been consulted and their guidance was followed. People had access to healthcare professionals when required and any concerns about people’s health were responded to quickly.
The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm.
The registered manager asked people for feedback about the service and their care on a regular basis and took action to address any issues raised. People had meetings where they could put forward their opinions about the food they were offered and activities they wanted to take part in. Complaints were recorded and responded to appropriately.
The registered manager attended local forums for managers and shared their learning with staff through team meetings. Staff treated people with dignity and respect; they understood confidentiality and people’s records were stored securely. Both the registered manager and the provider had clear oversight of the service and addressed any issues as they arose.