Kimberley Residential Home

People’s experience of using this service:

• The provider had made improvements to the way staff were recruited but had not ensured that medicines were always stored safely. Therefore, the domain of safe continues to be rated Requires Improvement. The domains of effective, caring, responsive and well led continue to be rated Good.

• One person had not received their medicine as prescribed on one occasion.

• The provider and manager took action during our inspection to make sure medicines were stored at a safe temperature. Medicines were stored securely.

• Medicines were ordered, administered, recorded and disposed of safely.

• Changes in people’s health had been identified and people were supported to see health care professionals when they needed.

• When people were at risk of losing weight they were referred to a dietician and offered a diet fortified with extra calories to reduce the risk of them losing more weight.

• Assessments of people’s needs and any risks to them had been assessed.

• Care had been planned to support people in the way they preferred and to keep them as safe as possible.

• People were supported to remain as independent as possible.

• Staff were kind and caring and treated people with dignity and respect.

• Staff knew the signs of abuse and raised any concerns they had with the manager or provider and action had been taken to keep people safe.

• People were not discriminated against and received care tailored to them.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

• People’s capacity to make specific decisions had been assessed and staff offered people choices in ways they preferred.

• The manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations when there was a risk that people may be deprived of their liberty to keep them safe.

• The new manager had been promoted from the role of deputy and provided consistent leadership

• People knew the provider and manager and told us they acted on what people told them.

• Staff told us they felt supported by the manager and were motivated.

• Checks and audits were completed and any shortfalls were addressed.

• The views of people and staff were requested regularly and used to improve the service.

• There were enough staff to care for people.

• New staff were recruited safely and had the skills they needed to meet people’s needs.

• Records were accurate and held securely.

Rating at last inspection:

Good (last report published 16/06/2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

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

Kimberley Residential Home provides accommodation for up to 36 older people who need support with their personal care, some people are living with dementia. Accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 26 single bedrooms and 5 double bedrooms, which people can choose to share. There were 32 people living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider’s recruitment procedures were not being followed. Information about the character and conduct of staff in their previous employment had not been checked to make sure staff did not pose a risk to people. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff were supported to provide good quality care and support. Staff had completed most of the training they needed to provide safe and effective care to people. Some staff held recognised qualifications in care. Staff met regularly with the registered manager to discuss their role and practice and any concerns they had.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations have to be applied for if people, who lack capacity, are at risk of being deprived of their liberty. Arrangements were in place to check if people at risk of being deprived of their liberty and apply to the supervisory body for a DoLS authorisation when necessary.

People’s needs had not been consistently assessed to identify the care they required. This did not impact on people as staff recognised changes in their needs and provided the care they required in the way they preferred. Care and support was planned with people and reviewed to keep people safe and support them to be as independent as possible.

People’s capacity to make decisions was not always assessed. This did not impact on people because staff made decisions in people’s best interests with people who knew them well. Consent to care had been obtained from people. People were supported to make decisions and choices. The requirements of the Mental Capacity Act 2005 (MCA) had been met.

People were treated with dignity and respect at all times. One person’s relative had commented, ‘Staff are aware of [person’s name] as an individual and always accommodate their funny little ways’.

The registered manager provided leadership to the staff and had oversight of the service. Staff were motivated and felt supported by the registered manager. The registered manager and staff shared a clear vision of the aims of the service. Staff told us the registered manager was approachable and they were confident to raise any concerns they had with them.

There were enough staff, who knew people well, to meet their needs at all times. The needs of the people had been considered when deciding how many staff were required on each shift. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager or the local authority safeguarding team. Plans were in place to keep people safe in an emergency.

People received the medicines they needed to keep them safe and well. Action was taken to identify changes in people’s health, including regular health checks. People were supported by staff to receive the care they needed to keep them as safe and well as possible.

People were supported to participate in a wide variety of activities that they enjoyed, including day to day household tasks. Possible risks to people had been identified and were managed to keep people as safe as possible, without restricting them.

People told us they liked the food at the service. They were offered a balanced diet that met their individual needs. A wide range of foods were on offer to people each day and they were provided with frequent drinks to make sure they were hydrated.

People and their representatives were confident to raise concerns and complaints they had about the service with the registered manager and provider.

The registered manager and deputy worked with people and staff and checked that the quality of the care was to the standard they required. Any shortfalls found were addressed quickly to prevent them from happening again. People and their representatives were asked about their experiences of the care and these were used to improve the service.

Accurate records were kept about the care and support people received and about the day to day running of the service. These provided staff with the information they needed to provide safe and consistent care to people.

The quality of the care was regularly assessed. People and their relatives were asked for their feedback about the quality of the service they received. Everyone said it was ‘good’ or ‘excellent’.

We made recommendations to improve practice in relation to effective recruitment processes and consistently assessing people’s capacity to make decisions.

Below is a summary of what we found. The summary is based on our observations during the inspection:- from speaking with people using the service, their relatives, and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe. People were treated with respect and dignity by the staff. People told us that they felt safe.

We looked at four people's individual plans of care and saw that they had individual risk assessments in place to identify potential risks and to show how these could be avoided or minimised. We saw that the assessments were reviewed regularly, and provided clear directions for staff to follow. This meant that there were ongoing procedures in place to maintain people's safety.

We inspected medication management and found that there were suitable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff. Medication procedures were robust and staff understood how to administer medicines safely in order to safeguard the people they supported.

Staff training records showed that all of the staff had completed required training, which included subjects such as fire awareness, moving and handling, infection control and food safety. They had also completed training in relevant subjects such as understanding end of life care and diabetes This meant that people were supported by staff with sufficient training to enable them to provide safe and effective care.

We found that records required to protect people's safety and wellbeing were maintained, held securely and available when required.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw that where appropriate people had signed and confirmed that they had been involved in writing their care plans and these reflected their current needs.

We found that the staff referred people appropriately to their GP and to other health and social care professionals. This meant that people had the care and treatment that they needed.

Is the service caring?

The service was caring. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. Although not everyone could express an opinion, one person told the expert by experience "I look forward to lunch" and another person who used the service talked as if it was her own home as she said "I go to my room whenever I like". Another person told the expert by experience "I have visitors but I am quite happy chatting to the others". It is nice here, the people are nice. I need help to move around but I do wish I didn't, but they are kind and they don't rush me".

The expert by experience reported that the atmosphere between staff and residents was caring and considerate.

Is the service responsive?

The service was responsive. We found that the staff listened to people, and took appropriate action to deal with any concerns.

Care plans showed that the care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people. This meant that their health needs were being met.

Is the service well-led?

The service was well-led. The manager was experienced and knowledgeable in relation to caring for people with varying degrees of dementia. The expert by experience reported that she had spoken with members of staff and it was evident that there was a good team spirit. One member of staff told her 'I enjoy working here, we all work together'. Another member of staff told the expert by experience "It really is home from home".

There were systems in place to provide on-going monitoring of the home. These included checks for the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.

People told us that the staff were kind and that there were enough staff to meet their needs. Staff spoke with people in a calm, positive reassuring manner. We saw a staff member hold a person's hand to comfort them when they became upset and asked them if they were alright. The person smiled and replied 'Thank you very, very much, you are wonderful' and responded positively to the comfort.

People maintained good health and mental health as the service worked closely with health and social care professionals. Activities were provided which people looked happy to join in with. For example, a hairdresser was at the home washing and drying people's hair, there were art and craft activities on offer and games like dominoes and bingo organised. Some people were folding towels and items of clothing which meant that they were occupied and engaged in a meaningful activity.

People were treated with respect and their dignity and privacy maintained. People said they felt safe and had the care and support they needed.

Visiting relatives told us 'The staff have been very good' and 'It's nice here, I have no complaints.'

People told us or expressed that they felt safe and well looked after. People looked relaxed and comfortable and at ease with each other and staff. People expressed that the home and their bedrooms were kept clean.

People said that they thought the staff were kind and caring. People said 'It is nice and clean and the staff are good and helpful' and 'They are always around when you need them'.

Visitors said 'The girls (staff) are very nice. They keep me informed and I like the way the staff relate to people' and 'The staff are very kind, it's lovely when they take people outside to enjoy the sunshine'.

People's health needs were supported and the service worked closely with health and social care professionals. A visitor said 'I looked at several homes and there is more mental stimulation here. (My relative) can socialise with others which is a bonus. It is bright with pictures that give stimulation which is very important, I think'.

Visitors said 'They don't mind when we come. They are doing an excellent job, above and beyond the call of duty' and 'The staff are very approachable, very patient as well. We are always made to feel welcome'.