Kynance Residential Home

The home was based on two floors connected by a passenger lift, in addition to a basement where the kitchen and laundry are located. There was a good choice of communal spaces where people were able to socialise, including a conservatory that was used as the dining room. All bedrooms had en-suite facilities.

The inspection was conducted on 5 and 10 April 2018 and was unannounced.

There was a registered manager in place. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection, in February 2017, we rated the service ‘Requires improvement’ and identified breaches of Regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to protect people effectively from the risk of choking and had failed to ensure people's care needs were met in a personalised way. The provider wrote to us, detailing the action they would take to address the concerns.

At this inspection, we found action had been taken to address all areas of concern and there were no longer any breaches of regulation.

The management team had made significant improvements to a range of processes and procedures, making them tighter and more robust to help ensure people were supported consistently in a safe and personalised way.

Three nutritional assistants had been appointed to support people to eat and drink safely and ensure their nutritional needs were met. This had helped people maintain a healthy weight.

Other individual and environmental risks to people were managed effectively. Risk assessments had been developed for all identified risks and people were involved in risk taking decisions.

People felt safe living at Kynance. Staff knew how to identify, prevent and report abuse. Safeguarding investigations were thorough and identified learning to help prevent a reoccurrence.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. The home was clean and staff followed best practice guidance to control the risk and spread of infection.

People’s needs were met by staff who were competent, trained and supported appropriately in their role. Staff acted in the best interests of people and followed legislation designed to protect people’s rights and freedom.

People described Kynance as homely. Some adaptations had been made to make the environment suitable for the people who lived there, including level access to an outside space.

People were supported to access healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care.

People were supported by kind, caring and compassionate staff. Staff made people feel they mattered by creating a family atmosphere and celebrating important events. They knew people well and supported people to maintain relationships that were important to them.

Staff expressed a commitment to treating people according to their individual needs, wishes and preferences. They protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in decisions about their care.

People’s needs were met in a personalised way. Each person had a care plan that was centred on their individual needs. Staff empowered people to make choices and responded promptly when people’s needs or preferences changed.

Staff worked in partnership with healthcare professionals to support people at the end of their lives to have a comfortable, dignified and pain-free death.

People had access to a range of activities. They knew how to make a complaint and felt any concerns would be listened to and addressed effectively.

People and their relatives felt the service was run well. Staff were organised, motivated and worked well as a team. There was a clear management structure in place and the registered manager had access to appropriate support.

There were effective quality assurance systems in place. People were consulted about the way the service was run and staff acted on feedback provided.

People described an open and transparent culture within the home, where they had ready access to the management and visitors were welcomed at any time.

There was a registered manager in place. 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.

At our last inspection, in February 2016, we identified breaches of two regulations. Decisions taken on behalf of people were not documented in accordance with legislation designed to protect people’s rights; and people were not protected from the risk of being deprived of their liberty unlawfully. Following the inspection, the registered manager sent us an action plan detailing how they would become compliant with the regulations. At this inspection, we found action had been taken to address these issues, but concerns were identified in other areas.

The provider had not displayed their previous quality rating on the premises, although this was rectified during the inspection. The provider had also failed to ensure that information was provided in writing to relevant people after significant accidents and incidents occurred.

One person’s safety was compromised as their drinks were not always thickened to the right consistency; this put them at risk of choking. Staff had received fire safety training, but not all senior staff were clear about evacuation procedures. However, other individual and environment risks were managed appropriately and protected people from harm.

Suitable arrangements were in place for the safe administration of medicines. However, checks showed that two people had not received all of their prescribed medicines and photographs of some people were not available to help staff ensure they gave the right medicines to the right people.

People with diabetes were not always supported to receive appropriate care or an appropriate diet in line with their individual needs and preferences. Their care plans did not provide sufficient information to enable staff to deliver diabetes care in a personalised way. However, other people’s dietary needs were met; people praised the quality of the food and were supported appropriately to eat and drink enough.

People’s other care needs, including support with personal care, were met. Care plans contained comprehensive information about the way each person wished to receive care and support. People were empowered to make choices; staff were led by people’s wishes and accommodated them wherever possible.

Staff had received safeguarding training and knew how to identify, prevent and report incidents of abuse. Robust recruitment procedures were followed to help ensure only suitable people were employed to support people.

Staff followed legislation designed to protect people’s rights and freedom. They were suitably trained and were supported appropriately in their role.

People had access to healthcare services and were seen regularly by doctors, specialists and community nurses. People also had access to a range of activities to meet their welfare needs.

People were cared for with kindness and compassion. We observed positive interactions between people and staff. Staff knew people well, spoke about them warmly and showed consideration for their feelings.

People were supported to maintain and build relationships and their spiritual needs were met. People’s privacy was protected. Staff encouraged people to be as independent as possible and involved them in decisions about their care.

The provider sought and acted on feedback from people. There was an appropriate complaints procedure in place and people had confidence that any concerns they raised would be addressed.

People were happy living at Kynance and felt the service was well run. There was an appropriate management structure in place. Staff were motivated, communicated effectively and worked well together.

The registered manager conducted a limited range of audits to monitor the quality and safety of the service, but was in the process of developing a more robust quality assurance system.

We identified breaches 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 this report.

There was a registered manager in place. 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.

People’s safety was compromised in some areas as some first floor windows did not have restrictors in place to prevent people falling and fire safety checks had not been conducted since the end of November 2015.

Other risks to people were managed effectively. However, measures needed to reduce the level of risk had not always been documented, so may not have been applied consistently.

Staff did not follow legislation designed to protect people’s rights and freedom or complete correct processes to help make sure decisions were only taken in the best interests of people. However, they did seek consent from people before providing care and support.

People received personalised care from staff who understood their needs and they were supported to make choices. However, this was not supported by the care planning system, which was not always personalised or up to date. The registered manager showed us a new care planning system they were introducing to address this.

People felt safe at the home. Care staff knew how to prevent, identify and report abuse, although non-care staff had not received safeguarding training.

Suitable arrangements were in place for managing medicines safely, but staff did not always record the use of topical creams or check that hand written entries on medicine records were accurate.

Whilst people received enough to eat and drink, we received mixed views about the quality and temperature of food. An extension was planned to the dining room to enhance the environment, and allow space for a food warmer, to help improve people’s mealtime experience.

Feedback was sought from people and changes were made to menus and activities as a result. However, two visitors felt they were not always listened to.

People were supported by sufficient staff and the registered manager followed safe recruitment practices. Staffing levels had recently been increased in order to meet people’s changing needs. Staff provided effective care; they were suitably trained and appropriately supported in their role.

People had access to healthcare services when needed. Staff enjoyed positive working relationships with external professionals, including doctors and nurses from the local surgery.

Staff treated people with kindness and compassion and formed caring relationships with them. They protected people’s privacy, promoted their independence and involved them in planning the care and support they received.

Staff recognised that people’s needs varied from day to day and responded effectively. People had access to a wide range of activities; these had been tailored to their individual needs and included trips to local attractions in the home’s minibus.

People liked living at the home and felt it was run well. There was a clear management structure in place. Staff understood their roles, were happy in their work and worked well as a team.

There was an open and transparent culture. The registered manager encouraged staff feedback and visitors were welcomed. Quality assurance processes were in place to assess key aspects of the service. These had identified the need for an improved care planning system, which the registered manager was implementing.

We identified two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

During our visit we spoke with four people who used the service and five members of staff including the registered manager, a health care professional who was visiting the home and two visitors. We observed how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.

People told us that they 'that the staff were helpful' and that the food was 'very good' and 'fair'. One visitor told us that the staff were ok and another that they had no complaints. A health care professional we spoke with told us that they visited the home regularly and that they had no concerns or issues with Kynance Residential Home. However during our visit one person raised concerns about their experiences whilst at the home.

We also spent time observing care in communal areas. We found people had positive experiences. We observed that staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. A group of people went out in the home's minibus on the morning of our inspection visit. The staff knew what care and support people needed and they respected their wishes. The care people told us they received matched with what was recorded in their care plans.

We found that medication was correctly managed and appropriate recruitment and induction procedures were followed. People received a varied diet with a choice provided at each meal. Care plans were relevant to people's needs and records were well maintained and stored securely.