This comprehensive inspection took place on 24 October 2018 and was unannounced.The last inspection of the service took place on 3 April 2018 when we rated the service requires improvement in all key questions and overall. At this inspection, although we found that some aspects of the service had improved, there were still concerns about the safety of people who used the service so we have rated the question, 'is the service safe?' as inadequate in and the question, ‘is the question well-led?' as requires improvement. The overall rating of the service is requires improvement.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. We received the provider’s action plan on 15 June 2018, telling us they would complete all actions by 20 June 2018.
Kent Lodge 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 service is registered to provide care for up to 38 people in a single building. Accommodation is provided on two floors.
The service is provided by Shaw Healthcare (Group) Limited, a national organisation providing health and social care. At the time of our inspection, there were 32 people living at the service, one of whom was in hospital.
There was a manager at the service. They had been the manager for six months. They were in the process of registering with the Care Quality Commission (CQC). 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. We received confirmation on 1 November 2018 that the manager had successful registered with the CQC.
Although improvements had been made, staff did not always follow the procedures to manage medicines. This meant that people were still at risk of not receiving their medicines safely and as prescribed.
Risk assessments were in place for each person, however, the level of risk was sometimes wrongly calculated which meant that risk management plans might not have been adequate to mitigate the risks. Guidelines and support plans were also not always reviewed and updated when the risk had increased.
A recent Food Standards Agency inspection had highlighted some concerns about the standards of hygiene in the kitchen. We saw that the provider had taken immediate action to meet requirements and make the necessary improvements.
The provider had processes for the recording and investigation of incidents and accidents, however, where a person using the service had a fall, staff were unable to show us a record of the accident report and actions in place to reduce future risks.
The provider had a number of systems to monitor the quality of the service and put action plans in place where concerns were identified. However, their systems had failed to identify the issues we found at this inspection or what the Food Standards Agency found.
We found the continuing breaches of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. We are taking further action against the provider. Full information about CQC’s regulatory response to these concerns will be added to the report after any representations and appeals have been concluded.
The provider did not always act in accordance with the Mental Capacity Act 2005 (MCA). Processes had not been followed where a person using the service was receiving their medicines covertly. We have made a recommendation regarding this.
Care plans were comprehensive and regularly reviewed. However, these included out of date documents. Staff told us they found them difficult to read.
People were protected by the provider’s arrangements in relation to the prevention and control of infection. The home was clean.
Recruitment checks were undertaken before staff started working for the service and included checks to ensure they had the relevant previous experience and qualifications.
People were supported by staff who were sufficiently trained, supervised and appraised. The service liaised with other services to share ideas of good practice.
People’s health and nutritional needs had been assessed, recorded and being monitored. People had access to healthcare professionals and the outcome of their visits were recorded.
People’s needs were met by caring and compassionate staff. On the day of our inspection, we saw that people were attended to promptly and staff were kind and caring.
People were given choice and were consulted in different aspects of their care and support. Their individual needs and wishes were respected, including their religious and cultural needs.
An introduction to end of life care training was provided during staff induction, and we saw that some people’s care plans included an advanced care plan. However, the registered manager acknowledged that this area needed to be developed further to ensure staff could meet the needs of people when they reached the end of their life.
A range of activities were organised and the activities coordinator told us they consulted people about what they wanted to do.
The provider had taken further steps since our last inspection to develop the design and decoration of the premises to meet the needs of people who used the service, in particular those living with the experience of dementia.
Complaints were recorded and responded to appropriately and in a timely manner.
Staff reported that the manager was effective and making improvements at the service. They found them approachable and visible, and felt valued and supported.
The manager told us they felt supported by senior managers and were working hard to continue making the necessary improvements.