Keb House Residential Home

Keb House is a residential care home providing accommodation and personal care for up to 18 older people including people living with dementia across 2 adapted areas within the grounds. At the time of our inspection 14 people were living at the service.

People’s experience of using this service and what we found

A system was in place to monitor the quality and safety of the service, however this was not always effective in identifying and addressing issues.

The safety of the service was not always maintained through regular checks.

Medicine practices were not always in line with best practice guidelines and staff did not always receive training to meet people's individual assessed needs.

Staff had been recruited safely however, records were not always thorough.

We have made a recommendation about recruitment processes.

People and staff spoke positively about the management of the service. There was a positive, caring culture within the service and we observed people were treated with dignity and respect. People were happy with

the care they received, they felt safe and well looked after.

Care plans included risk assessments for known risks and staff followed support plans to help keep people safe. Care plans were up to date, risk assessments were in place and regularly reviewed. People were regularly asked their views on the service provided and action had been taken when suggestions were made.

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.

The provider and staff worked in partnership with other health and social care agencies to deliver good outcomes for people and to ensure their needs were met and reviewed.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 January 2020). The service remains rated requires improvement.

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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider reviewed their systems to ensure effective infection control were in place. At this inspection we found the provider had made some improvements however further improvement was required.

Why we inspected

We carried out an unannounced inspection of this service on 31 October 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 safe care and treatment, medicine management 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 and well-led.

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 remained requires improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Keb House on our website at www.cqc.org.uk.

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.

Enforcement and Recommendations

We have identified breaches in relation to training, medicine management, risk management and good governance at this inspection. We have also made a recommendation in relation recruitment processes.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Keb House Residential Home is a care home in the village of Appleby. It is registered to provide accommodation and personal care to 18 older people, some of whom may be living with dementia. At the time of our inspection, 12 people lived at the service.

People’s experience of using this service and what we found

People were at risk of not having their medicines as prescribed. Relevant guidance was not in place to support staff with administering medicines and records were not always accurate. The safety of the service was not always maintained as safety certificates had expired. Systems were not in place to monitor and address quality shortfalls in the service.

Some furniture was not clean and appropriate hand washing facilities were not always available. We have made a recommendation about the cleanliness of the environment. Recruitment processes were safe, though records were not thorough. We have made a recommendation about recruitment processes. Records did not always accurately show the care people received.

The management team ensured staff were supported in their roles with supervision, appraisals and regular staff meetings, though not all staff had up to date training. We have made a recommendation about staff training and development. People and their relatives were happy with the management team as they were approachable and addressed problems.

People were happy with the care and support provided by staff. Staff respected people as individuals and supported people to maintain their independence. There was enough staff to meet people’s needs and people told us staff maintained their privacy and dignity.

People were supported to access healthcare services and staff followed professional advice. People’s rooms were personalised, and signs were used to help people find their way around. Activities were available for people and visitors were welcome at any time. People were complimentary of the choice and quality of the food and staff ensured options were tailored to people’s requirements.

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 were included in the development of the service and where possible changes were made in line with people’s requests.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We found the provider failed to notify us of nine specific incidents which had occurred at the service since the last inspection which the provider is legally required to inform us of. More information is in detailed findings below. We have also identified breaches in relation to the safe management of medicines, maintaining the safety of the service and the systems for monitoring and addressing quality shortfalls at this inspection. Please see the action we have told the provider to take at the end of this report.

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 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.

We undertook this unannounced inspection on the 4 January 2017. At the last inspection on the 7 January 2016 we found a breach in regulation. The registered provider had not always ensured the service was well maintained and in a good state of repair. The overall rating for the service was, “Requires improvement”. Following the inspection we received an action plan from the registered provider in August 2015 detailing how improvements would be made.

The service had a registered manager in post who was also the registered provider. A registered manager is a person who has registered with the 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.

During this inspection we found the cleanliness of the premises was satisfactory. The registered provider had made improvements to the general environment, which included redecoration to some areas of the older part of the building, such as a bathroom and the hall, stairs and landing. Two window frames in the main lounge had been re-painted and cracked glass replaced. The lights we checked during the inspection were all in working order, with the exception of one sensor light on an upstairs corridor where two bedrooms were located. We saw there was adequate ceiling lighting to compensate for this and the registered manager told us they would address this issue.

In the extension we saw nine bedrooms, the dining area and corridors had been re-painted. In one bathroom we found a bath support leg which was very rusty and in one bedroom we saw the person’s bed sheet had a rip in it. The registered manager addressed these issues immediately during this inspection.

It was recommended at the last inspection that the registered provider obtained information and direction from the local authority in respect of DoLS applications to ensure they are working within the principles of the Mental Capacity Act 2005 (MCA). At this inspection we found improvements had been made. The registered manager was following the principles of the MCA and seven applications had been submitted to the authorising body in respect of people being deprived of their liberty. The MCA legislation is designed to ensure that when an individual does not have capacity, any decisions are made in the person's best interest.

At the last inspection we made a recommendation for the registered provider to refer to good practice guidance with regard to making the environment more suitable for those people who may be living with dementia. At this inspection we saw there was pictorial signage as prompts to locate toilets, bathrooms, the kitchen and people’s bedrooms had signs on the door with their names on.

We also recommended at the last inspection that the registered provider reviewed the action plans produced following in house audits and ensured they were more detailed and robust in the recording. During this inspection we found improvements had been made to the maintenance recording and checks were more in depth and made on a weekly basis.

We found that people’s medicines were stored and administered appropriately. We saw medicine audits had not been completed since September 2016, but were completed regularly prior to that.

People living at Keb House said they felt safe and that staff were kind and caring. There were risk assessments in place to help reduce any risks related to people's care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

We found there was sufficient staff on duty to support people with their assessed needs. Staff had been recruited safely and appropriate checks were completed prior to them starting work at Keb House. Staff had good knowledge and an understanding of the needs of the people who used the service. Staff received regular supervision and an on-going training programme was provided to assist staff to increase their knowledge and skills.

Plans were in place for emergencies like a fire or a flood and staff knew what to do in the event of an emergency. Safety equipment and electrical appliances were all checked regularly.

We observed that staff spoke in a positive way to people and treated them with respect. Staff and people who used the service interacted in a positive way and observations showed good relationships existed between them.

We saw people had personalised care plans in place which included their likes and dislikes. People had regular access to the health and social care professionals involved in the care. Any recommendations and contacts with people had been updated in people’s plans of care. People's preferences were acknowledged and staff understood people's likes and dislikes. People were encouraged to participate in activities where they chose to.

People were given choices at mealtimes and they told us they enjoyed the meals. The atmosphere over the lunchtime period in the older part of the service was calm and relaxed with conversation taking place. Staff supported people to receive appropriate hydration and nutrition and took action when people became at risk of dehydration or malnutrition.

The service had a quality monitoring system in place, which ensured that checks were made and people were able to express their views. People told us they knew how to make a complaint. Information was on display at the service.

The registered manager understood their responsibilities to report accidents, incidents and other notifiable incidents to the CQC as required.

At the time of our inspection 12 people were been supported to live at the service. The service comprises of an older style Victorian house and a newer build single storey annex extension. The service offers en-suite rooms, various communal lounges and dining areas, a busy bee activity room, a kitchen, a laundry and outdoor garden space with seating areas. The service is accessible for people with mobility difficulties and onsite car parking is available.

The inspection was unannounced and took place on 7 January 2016. The last inspection was completed in December 2014 and the service was non-compliant in one of the five areas we assessed and required improvements in a further three areas. We then completed a follow up inspected at the service in March 2015 and found the service to be compliant. We did not change the overall rating of the service at the follow up inspection from requires improvement as we wanted to determine if the service could sustain the improvements that had been made over a longer period of time. The service had a 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.

We found the service required improvements to three out of the five key areas we inspected. During this inspection we found a number of maintenance issues that required attention at the service. These included chipped paintwork, peeling wall paper, cracked windows and poor lighting in areas of the service.

We saw that one of the bathrooms had a storage cabinet which contained bath and hand towels which should have been stored in the rooms of people who used the service to prevent cross contamination. There was also a build-up of dust and dirt behind the cupboard where it had not been cleaned sufficiently. We found this was a breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of this report.

Staff understood the principles and processes of safeguarding vulnerable people and had received training to support them. People living at the service said they felt safe and told us that staff were good and caring. We found that medicines were stored and administered appropriately in line with current guidance.

Staff had been recruited safely and appropriate checks were completed prior to them working with vulnerable people. Staff had good knowledge and an understanding of the needs of the people who used the service.

People were given choices at mealtimes, although the atmosphere over the lunchtime period was very quiet with no music playing and very little conversation taking place. Staff received regular supervision and appraisals and an on-going training programme was provided to assist staff to increase their knowledge and skills.

We observed that staff spoke in a positive way to people and treated them with respect. Staff and people who used the service interacted in a positive way and observations showed good relationships existed between them. People who used the service were offered a range of activities which they were encouraged to participate in.

We saw that accidents and incidents at the service had been documented and evaluated so that lessons could be learnt to help the service develop and improve. The registered manager was following the principles of the Mental Capacity Act 2005 (MCA) although no application had been submitted in respect of people being deprived of their liberty. The Mental Capacity Act 2005 (MCA) legislation is designed to ensure that when an individual does not have capacity, any decisions are made in the person’s best interest.

People who used the service had personalised care plans in place and their individual likes and dislikes were clearly documented. Risk assessments were in place together with information about people’s life histories and medical conditions to help staff meet their needs

The service had limited signage in place and required improvements to enable the environment to be more dementia friendly. Improvements were also required in relation to the auditing systems in place for the maintenance of the environment. The registered manager promoted an open door culture and staff told us the registered manager provided good support and was approachable.

We made a number of recommendations to the registered provider to assist with making overall improvements to the practice and processes at the service.

People who used the service told us they were 'Comfortable' and that staff were 'Kind and helpful.' People told us that staff supported their health needs and took prompt action to involve external professionals when this was required.

We observed there was a relaxed atmosphere throughout the service on the day of our visit. We saw staff interacted with people in a friendly way, offering gentle encouragement to ensure their involvement in choices about their support.

Relatives we spoke with told us they were satisfied with the service provided. They told us they visited regularly and that staff kept them informed about changes concerning their members of family. Relatives told us that staff, 'Do a wonderful job' and that they were, 'Always made to feel welcome, no matter what time of the day.'

We observed that people who used the service were clean and looked well cared for and that the building had no unpleasant smells. One relative told us the bedroom of their member of family was, 'Kept spotlessly clean' and that domestic staff ensured it was 'Always neat and tidy.'

People told us they were 'Comfortable' and that the service was 'Really, rather good.' We observed staff talking and listening to people in a friendly and compassionate manner to ensure their personal dignity was maintained. We saw that staff involved people in relation to their support, to ensure they were provided with choices about how this was delivered.

We found that information about people was unsystematically maintained. We found that further work was required to ensure accurate care planning information was available for people, to enable their support to be delivered in a planned and consistent way that ensured their welfare and safety.

People who used the service told us their comments were taken seriously by the provider and that they were confident action would be taken, to ensure any concerns were appropriately addressed. Recent letters of relative thanks commented: 'Thank you and your staff for the wonderful support you are providing' and 'Pleased to see the good care xxxxx is receiving.'

We found that a range of assessments of people had been carried out to ensure they were kept safe from potential harm, although we observed that reviews and evaluations of their support had not always been consistently recorded in recent months.

We found that staff were provided with training to help them to carry out their roles, however we found this had not always been renewed in a timely fashion.

We found that systems were in place to enable people to share their views about the service, but that administration systems needed further development to ensure that potential risks could be easily identified.