This inspection took place on 2, 3, 9 and 10 July 2018. The inspection was unannounced: staff in the service did not know we would be carrying out an inspection. At our last inspection in June 2017 we rated the service as requires improvement. We made recommendations regarding medicines and having person-centred care records. At the time there was not a registered manager in post. of our last inspection A new manager had been appointed and had yet to make their application to register with CQC. During this inspection we found breaches of regulations 9, 11, 12, 17 and 18. These appertained to the lack of person centred records, lack of consent obtained from people, unsafe care and treatment, lack of effective systems to monitor the service, out of date records, and lack of appropriate support to staff.
Kibblesworth 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 care home accommodates up to 16 people in one adapted building. At the time of our inspection 13 people were living at Kibblesworth. The home specialises in providing care to people living with an acquired brain injury.
At the time of our inspection there was no registered manager in post. 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.
Appropriate governance arrangements were not in in place to monitor and improve the service. Deficits we found during our inspection had not been identified when the limited audits in use had been applied to the service.
The service failed to use the guidance provided by National Institute of Health and Care Excellence on managing medicines in care homes. As a result, we found there were unsafe practices in managing the administration, storage and disposal of people’s medicines.
Staff had not completed daily roadworthy checks on the mini bus since January 2018. Arrangements were put in place during our inspection to re-commence these checks.
Checks were carried out on a regular basis to ensure people were cared for in a building which was safe. However, we found no fire drills had been carried out in line with the provider’s policy since December 2017.
People were sometimes put a risk of unsafe care through records which were out of date or inaccurate.
Pre-employment checks were carried out on permanent staff before they began working in the service. Staff had not been supported with training, supervision and appraisals. Agency nurses were working at service every day. Checks were not carried out on the agency staff to see if they were registered with the Nursing and Midwifery Council and were competent to meet people’s needs. Inductions into the service for agency staff failed to include any information on clinical practices. A new induction checklist for agency nurses was introduced to the service together with more rigorous checks on their competence before our inspection was concluded.
During our inspection visit furniture which could not be cleaned to reduce risks of infection spreading were removed. The home was clean and tidy throughout.
People who used the service were restricted with bedrails without having either their consent obtained or their capacity assessed with best interest decision being made. This meant the provider did not always meet the requirement of the Mental Capacity Act. Although staff including the manager had not been trained in Deprivation of Liberty Safeguards, applications had been made to local authorities to keep people safe.
Staff employed in the making of meals understood people’s dietary needs and how to make meals look appetising for those people who needed soft or pureed diets. The kitchen was clean with daily, weekly and deep clean practices in place.
Relatives told us they had not seen people’s care plans and they had not been invited to relative’s meetings. We found the involvement of relatives in the service was limited.
Since the last inspection one complaint had been made to the service. This had been considered and a response provided to the complainant.
An occupational therapist (OT) and an assistant occupational therapist were employed in the home. They assessed people’s needs and worked with them, their relatives and staff to put in place plans to promote people’s well-being.
Relatives spoke with us about the lack of stimulating things for people to do. Activities had been put in place by the OT for some people. We found people mainly spent their day in the lounges or their bedrooms watching TV. We made a recommendation about this.
People and their relatives made positive comments to us about the caring nature of the staff. Staff protected people’s privacy but needed training and understanding about dignity when supporting people to eat.
Further work was needed in the service to ensure care staff and occupational therapy staff were working together to meet people’s needs.
Partnership working with professionals outside of the home was evident in the records.
Staff understood about the need for confidentiality. Records were locked away and were inaccessible to other people.
You can see what action we told the provider to take at the back of the full version of the report.