We carried out a review of the data available to us about Kenyon Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Kenyon Lodge, you can give feedback on this service.
Kenyon Lodge is a residential care home registered with the Care Quality Commission to provide nursing and personal care for up to 60 people. The service provides support to older adults. The single room accommodation is arranged over two floors and has lift access. At the time of the inspection 36 people were using the service.
People’s experience of using this service and what we found
Systems in place helped safeguard people from the risk of abuse. Assessments of risk and safety and supporting measures in place helped minimise risks. Staff managed people’s medicines safely. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection.
Staffing levels were sufficient to meet people’s needs and managers recruited staff safely. Staff followed an induction programme, and training was on-going throughout employment.
Care plans included information about support required in areas such as nutrition, mobility and personal care to help inform care provision. Staff made appropriate referrals to other agencies and professionals when required.
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 told us they were well treated, and their equality and diversity respected. People felt staff respected their privacy and dignity and took into account their views when agreeing on the support required. Staff identified people’s communication needs and addressed these with appropriate actions.
The provider and manager responded to complaints appropriately and used these to inform improvement to care provision. The provider was open and honest, in dealing with concerns raised. The manager was available for people to contact, and managers undertook regular quality checks, to help ensure continued good standards of care.
The provider and managers followed governance systems which provided oversight and monitoring of the service. These governance systems and processes ensured the service provided to people was safe.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 27 September 2021).
Why we inspected
The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of the risk of falls. This inspection examined those risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and well-led sections of this full report.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kenyon Lodge on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Kenyon Lodge is registered with the Care Quality Commission to provide nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. At the time of the inspection 60 people were using the service.
People’s experience of using this service and what we found
Staff protected people from abuse and understood how to recognise and report any concerns they had about people's safety and well-being. Staff assessed people's needs before they started using the service. People had been involved in the care planning process. Staff managed people’s medicines safely. Infection control was managed well.
The provider followed safe recruitment processes to ensure the right people were employed. Staff training included an induction and ongoing training. There were enough staff to keep people safe. Staff assessed any risks to people's health and wellbeing and mitigated these risks. Care plans provided staff with the information they needed to meet people's needs.
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. Staff supported people to share their views and shape the future of their care.
Staff had formed genuine relationships with people, knew them well and were caring and respectful towards people and their wishes. Staff were dedicated to their roles and in supporting people to achieve their goals and aspirations. Staff supported people to access healthcare professionals and receive ongoing healthcare support.
Staff worked with other agencies to provide consistent, effective and timely care. We saw evidence that the staff and management worked with other organisations to meet people's assessed needs. The provider and manager followed governance systems which provided effective oversight and monitoring of the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 15 May 2019)
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach. 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kenyon Lodge on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Kenyon Lodge is owned by Trees Park (Kenyon) Limited, trading as Abbey Healthcare. The service is registered with the Care Quality Commission to provide nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. On-site car parking is available, and the service is situated on a local bus route and is close to the motorway network.
At the time of the inspection 25 people were receiving nursing care on the first floor of the home and 11 people were receiving residential care on the ground floor of the home. A comprehensive refurbishment of the upstairs floor of the building had been undertaken since the last inspection.
People’s experience of using this service:
The service had an open and supportive culture. Systems were in place to monitor the quality and safety of care delivered. There was evidence of improvement and learning from any actions identified.
There were sufficient numbers of trained staff to support people safely. Recruitment processes were robust and helped to ensure staff were appropriate to work with vulnerable people.
People’s needs were thoroughly assessed before starting with the service. People and their relatives, where appropriate, had been involved in the care planning process.
Staff were competent and had the skills and knowledge to enable them to support people safely and effectively. Staff received the training and support they needed to carry out their roles effectively. Staff received regular supervisions and annual appraisals were planned.
Staff had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risk where possible.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff supported people to access other healthcare professionals when required. Staff supported people to manage their medicines safely.
People’s outcomes were consistently good, and people’s feedback confirmed this.
Staff worked with other agencies to provide consistent, effective and timely care. We saw evidence that the staff and management worked with other organisations to meet people’s assessed needs.
We observed positive interactions between staff and people. Staff had good relationships with people and were seen to be caring and respectful towards people and their wishes.
People were supported to express their views. People we spoke with told us they had choices and were involved in making day to day decisions.
The provider and registered manager followed governance systems which provided effective oversight and monitoring of the service.
The premises were homely and well maintained. We observed a relaxed atmosphere throughout the home.
The service met the characteristics of Good in all areas.
Rating at last inspection:
At the last inspection of the service (published 04 May 2018) the home was rated Requires Improvement overall and there were two breaches of regulations in relation to safe care and treatment and good governance. At this inspection the overall rating has improved to Good.
Why we inspected:
This was a planned inspection based on previous the rating.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the five key questions to at least good and the provider subsequently submitted action plans to CQC on a monthly basis. We also held regular meetings with the provider, local authority and clinical commissioning group (CCG) to monitor progress and to review the action plan.
At this comprehensive inspection on 01 and 02 February 2018 we found the provider had taken remedial action to improve some of the ratings but further work was needed to ensure compliance with all regulations. During this inspection, we found the process of improving the ratings was on-going and a work-in-progress and there were still breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.
Kenyon 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.
Kenyon Lodge is owned by Trees Park (Kenyon) Limited, trading as Abbey Healthcare. The service is registered with the Care Quality Commission to provide nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. On-site car parking is available and the service is situated on a local bus route and is close to the motorway network. At the time of the inspection 18 people were receiving nursing care and 12 people were receiving residential care, all on the ground floor of the home. A comprehensive refurbishment of the upstairs floor of the building was due to start in May 2018 and this part of the building was empty and no-one was residing there at the time of the inspection.
Medicines were not consistently managed safely. Protocols were not always in place for all people prescribed a medicine ‘when required’; some protocols were dated 2016 and had not been reviewed to check they described the person’s current needs. Two people’s prescribed creams were out of stock. Nurses carried out daily stock checks of controlled drugs (CD’s) for people in their care but did not check CD’s prescribed for people receiving only personal care.
Regular audits were carried out in a number of areas but had not always been effective in identifying and resolving some of the issues we found during the inspection in regards to management of medicines and care planning documentation.
Accidents and incidents were recorded and audited monthly to identify any trends or re-occurrences but not all records were up to date and some did not clearly identify the actions taken following falls.
There was 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.
Comments received from people who used the service and their relatives about the registered manager were very complimentary, and everyone reported significant improvements had been made since the date of the last inspection. Comments from staff were also positive and all staff reported improvements in management since the date of the last inspection.
People living at Kenyon Lodge told us they felt safe and said staff were kind and caring. Staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse that could occur. There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm.
Staff had access to a wide range of policies and procedures regarding all aspects of the service.
Staff now received appropriate induction, training, supervision/appraisal and there was a staff training matrix in place. Staff told us they now received sufficient induction and training and this enabled them to feel confident when supporting people.
We saw there were individualised risk assessments in place to identify specific areas of concern and care plans were person-centred and covered essential elements of people’s needs and preferences. Staff sought consent from people before providing support. People’s health needs were managed effectively and there was evidence of professional’s involvement regarding people’s care.
Equipment used by the home was maintained and serviced at regular intervals. The home was clean throughout and there were no malodours. The environment was suitable for people's needs.
There was evidence of robust and safe recruitment procedures.
The home had been responsive in referring people to other services when there were concerns about their health.
People told us the food at the home was good. There was a seasonal menu in use and this was displayed. People’s nutritional needs were monitored and met.
People told us staff treated them well and respected their privacy and dignity. We observed positive interactions between staff and people who used the service.
When people had undertaken an activity this was recorded in their care file information and there was a range of activities available for people to choose from.
The service aimed to embed equality and human rights though good person-centred care planning and people were provided with a range of useful information about the home and other supporting organisations.
The service was supported by other relevant professionals when providing end of life care. Several relatives had commended the home for the quality of its end of life care provision.
There was a complaints policy and procedure in place. This clearly explained the process people could follow if they were unhappy with any aspects of their care.
There was a service user guide and statement of purpose in place.
Formal feedback from people who used the service and their relatives was sought and there were regular meetings with them.
The service worked in partnership with other professionals and agencies in order to meet people's care needs.
There was an up to date certificate of registration with CQC and insurance certificates on display as required. We saw the last CQC report was also displayed in the premises as per legal requirements.
We carried out an unannounced inspection of Kenyon Lodge on 22 and 23 August 2017. We then carried out a further day of inspection on 20 September 2017 to check on the progress the provider had made since the date of the first inspection, and to check on people’s welfare. The inspection had been brought forward due to a significant number of safeguarding issues and concerns, including one serious incident. We are making further enquiries in relation to this incident.
When the home was inspected on 06 October 2015 the home was given an overall rating of inadequate and was placed into ‘special measures’ by CQC. The service was re-inspected on 25 May 2016 and again on 26 October 2016, where improvements were noted and the home was given an overall rating of requires improvement.
During this inspection, we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to safe care and treatment, safeguarding, meeting nutrition and hydration needs, good governance, person-centred care and staffing requirements. We are currently considering our enforcement options in relation to these regulatory breaches.
At the time of the 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 and associated Regulations about how the service is run. A manager had recently been appointed but had not yet commenced their application with CQC.
People and their relatives told us they did not always feel they were safe living at the home. Relatives told us they felt the home was short staffed and people’s needs were not met in a timely way as a result of this. We received negative comments regarding the care provided. One relative told us [their relative] was unkempt and they didn’t have confidence in the care because nurses were not always sure about the treatment [their relative] had received. One staff member told us they would not want their own relative in the home.
People were not safeguarded from abuse as staff were not recognising safeguarding incidents and referring them to the local authority. We found at the time of the inspection there was a high number of safeguarding incidents, currently being investigated. Of these, the majority had been raised by visiting health care professionals.
A number of the safeguarding concerns related to the management of pressure care and wounds. We found information regarding the management of pressure care was inconsistent and differing instructions relating to the frequency pressure relief should be provided. This had placed people at risk of their skin breaking down.
Medicines were not handled, stored or administered safely. Effective systems for the safe administration and storage of drink thickeners were not in place, which placed people at risk of harm. Although medicines had been audited regularly, audits had failed to identify the issues we found during the inspection regarding the unsafe management of medicines.
The building was being adequately maintained, which ensured the premises were safe. People were protected from the risk of infection, as the provider had ensured good infection control practices were in place. This had been verified by the local infection control team.
Staff including the cook and kitchen staff did not have access to information and guidance about people’s nutrition and hydration needs. This placed people at risk of choking or aspiration. For people, who required their food and fluid intake to be monitored, record keeping was poor, and there were no system in place to check records had been completed, and act on any identified issues.
Staff were being recruited safely, and once in post had access to an induction programme. Staff had not consistently received sufficient training and supervision to ensure they had the skills required to support people effectively.
Care plans had not been reviewed regularly and updated to ensure they reflected people’s current needs and preferences. Record keeping was poor. People did not consistently receive care that met their needs and preferences.
There was a complaints policy and procedure in place in addition to a complaints log and details of how to complain were posted around the building.
We identified significant shortfalls in the care provided to people at the home. This was linked to ineffective governance arrangements and leadership both by the provider, and through the management arrangements in place at the home. A monthly log of accidents/incidents was kept. However these had not been audited by the provider to identify any trends or patterns to prevent re-occurrence. The provider had failed to notify CQC of several notifiable events.
We shared our concerns with local commissioners, who have undertaken reviews of all people living in the home, and supported the provider in making immediate improvements to ensure people’s safety. Following the inspection the provider submitted an action plan to CQC and commissioners identifying how they intended to address our concerns. The action plan is being updated and shared regularly.
The overall rating for this provider is ‘Inadequate’. This means that the home has been placed into ‘Special measures’ by CQC.
The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve;
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made;
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Kenyon Lodge provides nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. A car park is available and the home is close to bus routes and a motorway network. On the day of the inspection there were 36 people using the service, of which 14 were in residential placements and 22 in nursing.
There was a registered manager at the service. 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.
The inspection had been brought forward due to a significant number of safeguarding issues. Some of these were subsequently substantiated and failings identified within the service. Corrective measures were now being put in place and needed to be sustained in the future to help ensure people’s continued health and well-being.
People told us they felt safe and secure at the home. The service’s recruitment procedures were robust and helped ensure people employed at the service were suitable to work with vulnerable people.
Staffing levels were sufficient to address the needs of the people who used the service and were based on a dependency tool. This was to be updated to ensure busy times were always covered appropriately.
Individual and general risk assessments were in place and these were reviewed and updated as required. We saw evidence of health and safety checks and regular maintenance of equipment.
Medication systems were safe and medicines were ordered, administered, stored and disposed of appropriately. Some issues, such as the application and documentation of topical creams needed to be tightened up.
Staff demonstrated a good understanding of people who used the services. Induction was thorough and training was on-going. This helped ensure staff’s skills and knowledge were kept up to date.
The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) applications were made appropriately. Consent was sought for all interventions and there was no use of restraint at the home.
People’s nutritional and hydration needs were assessed. Referrals to other agencies were made appropriately and advice followed where necessary. Special diets and requirements were adhered to by the service.
People told us they were cared for with kindness and we observed good interactions between staff and people who used the service throughout the day. We saw that staff respected people’s privacy and dignity at all times.
People who used the service, and their relatives where appropriate, were encouraged to be fully involved in care planning. People were supported to be as independent as possible.
Staff had undertaken training in end of life care and efforts were made to ensure people’s end of life wishes were adhered to.
Care plans were person-centred and included a range of health and personal information. This helped staff care for people in the way in which they wished to be cared for. Care plans were regularly reviewed, but we found a few inconsistencies in documentation. There were a range of activities on offer at the home.
Complaints and concerns were dealt with appropriately and people were aware of how to make a complaint or raise a concern.
People who used the services and relatives described the manager as approachable. Staff said they were well supported and supervisions and appraisals took place on a regular basis. Staff meetings were also held regularly so there were a number of forums for staff to discuss issues or raise concerns.
Notifications had not been submitted in a timely manner to CQC prior to the inspection. Although this had now been addressed by the registered manager, they needed to demonstrate that appropriate notifications would be submitted in a timely manner in the future. We are following this up outside the inspection process.
The home had effective systems in place for quality assurance and audit. Results of audits were analysed in order to drive improvement within the service.
Kenyon Lodge is owned and operated by Trees Park (Kenyon) Limited, trading as Abbey Healthcare. The service is registered with the Care Quality Commission (CQC) to provide nursing and personal care for up to 60 people. Single room accommodation is arranged over two floors with lift access. On-site car parking is available and the home is situated on a local bus route and close to the motorway network.
At our last inspection of Kenyon Lodge on 06, 07 and 13 October 2015, we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. The home received an overall rating of ‘Inadequate’ and was placed into special measures. We took enforcement action against the Provider and issued four warning notices in respect of; Safe care & treatment; Meeting nutritional & hydration needs; Good governance; and Staffing. The provider submitted a Service Improvement Plan which gave timescales for the improvements that were required. During this inspection, we found the provider was now compliant with each of the warning notices we had served.
We found one continued breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regards to consent and mental capacity assessments. This breach had previously been identified during our last inspection and we found insufficient progress had been made in this area during this inspection. You can see what action we have taken at the back of the full version of this report.
Since our last inspection, CQC had been working collaboratively with Kenyon Lodge, stakeholders from Salford City Council and Salford NHS Clinical Commissioning Group, to monitor and assess the effectiveness of the Service Improvement Plan. This was to ensure people who used the service received care and support that was safe and met their individual needs.
At the time of our last inspection, a new manager had been appointed to Kenyon Lodge and the manager had submitted an application to CQC to become the Registered Manager. Following the outcome of this inspection visit, the manager’s application to become the Registered Manager was approved. A Registered Manager is a person who has registered with CQC. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
During our last inspection we found improvements had been made in the way medicines were being managed. However, during this inspection we found there had been a deterioration in the way some people’s medicines were being managed on a day-to-day basis and that improvements were needed in this area.
We asked people living at the home if they felt safe and they told us they did. We looked to see how the service sought to protect people from abuse and found there were appropriate safeguarding and whistleblowing policies and procedures in place. All the staff we spoke with demonstrated they had an understanding of the types of abuse and the procedure to follow if they suspected that a person was at risk of, or was being abused.
We asked staff about whistleblowing. All of the staff we spoke with told us they would not hesitate to use the policy and identified internal reporting protocols. Staff also referred to local authority and CQC as external agencies they could contact.
We looked at staffing levels to ensure there was enough staff to meet people’s needs. At the time of our inspection the home was not at full occupancy. 21 people were accommodated on the nursing unit and 17 people were accommodated on the residential unit. We saw that a dependency tool was used by the home to determine the number of staff required and that staffing levels were consistently reviewed to meet people’s needs. We sought reassurance from the management team that staffing levels would be kept under constant review as the home steadily increased admissions.
We looked at recruitment procedures and found robust and safe recruitment practices were in place.
Since our last inspection, we found notable improvements in staff training, supervision and professional development.
We found improvements had been made which ensured people’s day-to-day nutritional and hydration needs were being met. Improvements included the accurate completion of food and fluid charts, which were regularly checked and verified by a member of the management team, people’s weight was being regularly monitored and recorded and people’s nutritional action plans were being followed as prescribed.
People we spoke with told us they thought there had been a cultural change at Kenyon Lodge which now translated into better quality of care.
Throughout our inspection we observed a number of positive interactions between staff and people living at Kenyon Lodge. We saw staff treated people with kindness and compassion. People’s dignity was maintained and staff were respectful of people’s individual choices.
During this inspection, we spoke at length with two people who had additional physical health needs which meant they were cared for in bed. They told us they felt isolated and that apart from contact with the care staff and their visiting relatives, they did not feel part of the wider community at the home.
We found improvements had been made to the overall quality and standard of care planning documentation. This included a wide range of new and updated clinical information relevant to people being cared for on the nursing unit, and new and updated social care and support information for people being cared for on the residential unit.
We looked at how information was communicated within the home when a healthcare professional had been to visit a person living at Kenyon Lodge. We found information was not always documented by the visiting healthcare professional at the time of their actual visit and was often completed retrospectively by a member of the nursing or care staff.
There was a complaints policy and associated procedure and information about how to make a complaint was readily available.
People told us they thought the home was well-led. The manager was visible in the home and actively involved in the provision of care and support. Throughout the course of the inspection we saw the manager walking around the home and observing and supporting staff.
Audit and quality assurance was completed on a regular basis and covered a wide range of topics. We saw that where internal audits had identified issues, action was taken and lessons learnt were disseminated amongst the staff team.
We carried out an unannounced inspection of this service on 6 October 2015, with a further two announced inspection visits on 7 and 13 October 2015.
Kenyon Lodge is owned by Trees Park (Kenyon) Limited, trading as Abbey Healthcare. The service is registered with the Care Quality Commission to provide nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. On-site car parking is available and the service is situated on a local bus route and is close to the motorway network.
At our last inspection of Kenyon Lodge on 19 and 20 May 2015, we found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to safe care and treatment and staffing. As a consequence of this, we gave an overall performance rating of ‘Requires Improvement’.
At the time of this inspection there was no registered manager in post at Kenyon Lodge. However, a new manager had been appointed and they were applying to the Care Quality Commission (CQC) to register as the registered manager for the service. A registered manager is a person who has registered with the CQC. Like registered providers, they are ‘registered persons’. Registered persons have a 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 eight breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to person-centred care, dignity and respect, need for consent, safe care and treatment, meeting nutritional and hydration needs, good governance, staffing and requirement as to display of a performance rating. We are currently considering our enforcement options in relation to these regulatory breaches.
We found there to be insufficient numbers of suitably qualified and experienced staff to meet the needs of people who used the service. In particular, we found insufficient numbers of qualified registered nurses. The nursing unit at Kenyon Lodge can accommodate up to 30 people, yet we found for the vast majority of time only one registered nurse would be on duty. At the time of our inspection the service had three registered nurse vacancies and was reliant on the use of agency nurses.
The service did not always complete regular nurse-led assessments and reviews of people who used the service. This meant the service did not always recognise and respond to people who presented with clinical features of a condition that was likely to deteriorate. For example, during our inspection we found the service had failed to recognise and respond appropriately to a person who used the service who was clinically dehydrated.
During our last inspection of Kenyon Lodge we found the service was in breach of Regulation 12 of Health and Social Care Act 2008 because people who used the service were not protected against the risks associated with the safe management of medicines. However, during this inspection, we found significant improvements had been made. We found that medicines were now stored, administered, recorded and disposed of safely and correctly. Additionally, staff were adequately trained and kept relevant records.
We looked at how people who used the service with a high risk of malnutrition were being supported. This group of people each had a nutritional action plan prescribed for them by a community dietitian. However, the service was unable to demonstrate how peoples’ meals had been fortified and whether additional nutritional supplements were being provided. Furthermore, we found regular weights were not always obtained, recorded and acted upon.
Care and support plans of people who used the service at Kenyon Lodge were not of a consistently acceptable standard. We found gaps and omissions in recording and information was disorganised and not easy to understand. We found care plans were not sufficiently person-centred and did not effectively demonstrate peoples' likes, dislikes, personal preferences and their life history. Care plans also failed to demonstrate how people who used the service, and/or their lawful representatives, had been involved in planning and agreeing the care and support being provided.
We found the service did not always fully complete individual risk assessments for people who used the service. We found gaps in recording and some individual risk assessments in peoples' care plans were blank. Recording of accidents and incidents was inconsistent, particularly around falls. In a number of care plans we were unable to establish how people who fell on multiple occasions had been kept safe and what preventative strategies had been considered or implemented.
Personal emergency evacuation plans (PEEP) were not always completed and the evacuation status of each person who used the service was not readily available as the service did not maintain a PEEP ‘grab file’ in case of emergencies.
We looked at how staff were supported to raise concerns. The service had a whistle-blowing policy and associated procedures which contained the contact details of relevant agencies and internal contacts within Abbey Healthcare. However, despite the service having such policies and procedures in place, we found documentary evidence which demonstrated that not all staff had been supported appropriately when attempting to raise concerns about care and staffing.
We looked at a sample of recruitment files to make sure safer recruitment practices were being followed. We found the identity of people applying to work at the service had been checked, references had been sought and checks had been completed with the Disclosure and Barring Service (DBS). A DBS check helps to ensure that potential employees are suitable to work with vulnerable people.
We looked at how well people were protected by the prevention and control of infection. We found the service had previously been working with the local authority infection prevention and control team and had achieved an overall IPC audit score of 91%. However, we found over recent months attention to IPC issues had deteriorated. This was reflected in the services last audit which demonstrated an overall deterioration in IPC standards and an audit score 73%.
At our last inspection of Kenyon Lodge, we found the service was in breach of Regulation 18 of the Health and Social Care Act 2008 because professional development and supervision of staff was not effective. During this inspection, we found some improvements had been made to the frequency of one to one supervision. However, insufficient improvements had been made to professional development of staff.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA , and whether any conditions on authorisations to deprive a person of their liberty were being met.
We found the service had a policy in place concerning DoLS and information was included about best interests, lasting power of attorney and access to an Independent Mental Capacity Advocate (IMCA). DoLS literature was also clearly displayed in the reception area.
We looked at DoLS documentation concerning six people who used the service on the nursing unit and found that due processes had been followed by the service for each DoLS application and that decisions were made in those peoples' best interests. However, on the residential unit we found only two people who used the service to be the subject of a DoLS, this was despite the residential unit caring for significant numbers of people who lacked capacity and were not free to leave of their own accord.
We looked at the meal time experience for people who used the service on both the residential and nursing unit at Kenyon Lodge. We found dining tables were presented appropriately with table cloths, crockery and condiments. People who used the service told us the food was generally good and appetising. However, on the nursing unit, we found lunch time meal service was chaotic and noise levels were very high. On the residential unit we found the atmosphere to be less chaotic.
Kenyon Lodge employed two activity coordinators. We found information was displayed on a number of notice boards around the service which gave details of various activities. These included a knitting club, visit by a live singer and other activities such as board games and arts and craft. Holy communion was also available to people of faith.
During our last inspection of Kenyon Lodge in May 2015, the provision of end of life care was under review following a safeguarding incident. As part of this review, additional clinical support was provided to Kenyon Lodge by the local NHS district nursing service. At the time of this inspection, the review into end of life care was still on-going. However, we found one example of a person who used the service who was nearing the end of life had not been referred by Kenyon Lodge to appropriate palliative care professionals. The early intervention of such professionals is crucial to ensure those people nearing the end of life, are able to do so in a dignified and comfortable manner.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
This unannounced inspection was carried out on the 19 and 20 May 2015.
Kenyon Lodge provides nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. A car park is available and the home is close to bus routes and a motorway network.
There was no registered manager in place at the time of our inspection. However, a new manager had been appointed who had previously worked as the deputy manager at the home and was very knowledgeable about of all aspects of the service. They were currently applying to register with CQC as the registered manager for the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At the last inspection carried out in April 2014, we identified concerns in relation to the management of medication and assessing and monitoring the quality of service provision. We undertook a follow-up Inspection in August 2014 to ensure the service had implemented improvements and found that the service had addressed those concerns.
During this inspection, we found two breaches of Regulations under 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 the report.
Without exception, every person we spoke with told us they either felt safe or believed their family member was safe living at Kenyon lodge. One person who used the service told us; “I feel safe living here. No concerns at all.” Another person who used the service said “I’m quite happy and I do feel safe. The staff are lovely and look after me.”
As part of this inspection we checked to see how the service managed medication safely. We looked at a sample of 14 medication administration record (MAR) charts. We found that photographs were not always in place to ensure medicines were administered to the right people. The MAR sheets for people who resided in the Nursing Unit were reviewed and signatures omissions were found in seven records. This meant we could not be certain that medicines were administered in line with their prescription.
From examination of records we found evidence of topical cream recording charts for people were in place and were kept in people’s rooms. However, instructions recorded on the MAR by the pharmacist were not always accurately duplicated to the records maintained in people’s bedrooms. For example, in one instance pharmacist instructions clearly stated that ‘cream should be applied when required,’ while the instructions in the bedroom stated ‘apply after each wash.’
We found examples of where creams had been prescribed to people, however we found no records to indicate that the creams had been administered. This meant it was not possible to tell if a course of treatment had been administered correctly.
We found two examples of eye drops that had been opened, where the manufacture’s instruction clearly stated that the medicine should be discarded after 28 days. No date of opening had been recorded on the package to ensure staff could follow the manufacturer’s instructions safely.
On completing a stock control of the controlled drugs we found that a person had two supplies of exactly the same medicine, which were documented in two different areas of the Controlled Drugs Register. This double entry had the potential to cause the person harm as the drug count would depend on the stock balance that staff used at the time.
We found that the registered person had not protected people against the risk of associated with the safe management of medicines. This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with regards to safe care and treatment.
We looked at the training staff received to ensure they were fully supported and qualified to undertake their roles. We looked at training records and found that less than half of staff at the home had completed their annual e-learning in relation to safeguarding and less for the Mental Capacity Act (MCA). Training records also demonstrated that a number of staff were overdue training in a number of training areas including fire awareness, manual handling and infection control. One member of staff said “We have to do training in own time, but I’ve been here twelve months and have not received any manual handling training. I don’t feel I’m getting much personal development.”
We looked at supervision and annual appraisal records and spoke to staff about the supervision they received. We found that not all staff were receiving regular supervision. One member of staff told us; “I don’t have regular supervision, I think it’s because we are short of a deputy manager.” Another member of staff said “I have not received any recent supervision.”
We found that the registered person had not ensured all staff received appropriate professional development and supervision. This was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to staffing.
We checked to see how people who lived at the home were protected against abuse. We found people were protected against the risks of abuse because the home had a robust recruitment procedure.
We looked at whistleblowing instructions kept within the manager’s office, which contained the contact details of the manager, the regional manager, social services, clinical commissioning group and CQC. Staff were encouraged to report any concerns they had regarding poor practice or abuse. However, some staff we spoke with had limited knowledge regarding the principles and aims of safeguarding vulnerable adults.
We found the service undertook a comprehensive range of risk assessments to ensure people remained safe.
We looked at how the service ensured there were sufficient numbers of staff on duty to meet people’s needs and keep them safe. We looked at staffing rotas and a dependency tool used by the service to determine staffing levels. On the day of our inspection, we found the atmosphere was calm and there were sufficient numbers of suitably qualified staff on duty to meet people’s needs. On the whole, people we spoke with told us they thought that there was enough staff on duty throughout the day to meet their needs, but raised concerns about staffing levels at nights and weekends.
The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. We saw there were procedures in place to guide staff on when a Deprivation of Liberty Safeguards (DoLS) application should be made. However, some staff demonstrated a very minimal understanding around the principles of Mental Capacity Act (MCA) with regards to DoLS and reported that they had not received any training.
We found the home did have signage features that would help to orientate people living with varying degrees of dementia. We have made a recommendation about environments used by people with dementia.
During our inspection we checked to see how people’s nutritional needs were met. People were allowed to eat at their own pace. The food looked appetising and most of the people finished their meal. In the nursing unit, we found a high number of people who used the service required assistance to eat their meal. This was completed in a controlled and calm manner with staff interacting with questions such as ‘are you enjoying your food’ or ‘is your food too hot’. Lunchtime was pleasant experience for people who used the service.
People and relative told us they or their loved one were well cared for at the home. One person who used the service told us; “The carers are lovely. If I call them using the call thing, they come straight away.” Another person who used the service said “They are all lovely they look after us very well even when they are under pressure they are always polite.”
Throughout the inspection we observed staff providing treatment and care in a kind and sensitive manner. People told us that care staff were polite, respectful and protected their privacy. A member of staff was chosen each day to be the service dignity champion and was expected to be the eyes and ears of each unit, observing practice and noting any disrespectful behaviour. They ensured that the dignity of people was respected at all times.
People and relatives told us they were involved in making decisions about their care and were listened to by the service. They told us they had been involved in determining the care they needed and had been consulted and involved when reviews of care had taken place.
On the whole most people we spoke with said the home was very responsive to their needs. However, one person and their relative told us that they were not wholly happy with the care provided and felt their relatives needs were not being met.
We found bedrooms were small and bright with beds suitable for the different needs of the residents. We noticed a lack of seating in the bedrooms for visitors, forcing relatives and visitors to sit of the bed.
During our inspection we noted 10 people in the nursing unit remained in their beds during the late morning. We found that care plans for five of these people had documented reasons why the people were still in their beds. For the remaining five people, care plans did not document any known reasons as to why they were being cared for in bed.
‘Flash meetings’ where conducted by staff at the start of each shift, which acted as a handover and included any developments affecting people and was also an opportunity for management to share important information with staff.
The service employed two activity coordinators at the home. We looked at pictorial evidence of people enjoying themselves in the gardens and showing past events and celebrations. A theatre group and singers come to entertain on a regular basis and a Gospel choir was due to visit the home. We saw Union Jacks displayed in the entrance celebrating VE day.
The service sent out satisfaction surveys to people who used the service and their relatives as well as employees. We looked at minutes from a residents and relatives’ meeting. Where concerns had been highlighted, these had been recorded on a notice board in the main reception area with the action taken by the service to address the issue.
All the people we spoke with on the day of our inspection knew who the manager was. They thought the new manager had a very visible presence in the home and felt confident and happy to approach her with any concerns they may had. Staff we spoke with told us they felt valued by management who were approachable and supportive.
The service undertook a comprehensive range of audits of the service to ensure different aspects of the service were meeting the required standards. However, we looked at a recent medication audit that identified missing photographs from medication records with no evidence of any action taken. In view of our findings around medication, which included the omission of some photographs, we questioned the effectiveness of these audits.
The service identified ‘lessons learnt’ from incidents, accidents, complaints and safeguarding. In response the service highlighted what it had learnt and what had changed as a result. This information was shared with staff through group supervision, staff meetings and daily ‘flash meetings.’
During the inspection we reviewed how medication was administered and recorded. We found medicines were safely administered and people who used the service received their medicines in the way they had been prescribed.
We found medication administration records (MAR) had been completed correctly and signed by the dispensing member of staff.
We looked at weekly and monthly audits that were now routinely undertaken. Where errors or admissions were identified we saw evidence that the service addressed these issues immediately.
We found there were systems in place to monitor the quality of the service provided.
We looked at a sample of four recently completed questionnaires that had been received by the service.
We looked at minutes from a recent residents and relatives meeting. We found that where concerns had been raised these had been addressed by the service
We found evidence that supervision with staff was now regularly undertaken and that training needs had been identified for each member of staff.
Our inspection was co-ordinated and carried out by two inspectors, who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found.
The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, 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?
People told us they were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service said 'I feel safe, they look after me very well. No concerns, staff are very kind and helpful.' Safeguarding procedures were in place and staff were able to demonstrate how they would safeguard the people they supported from abuse.
There were no clear consistent systems in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This meant that people were not benefiting from a service that was taking on board lessons learnt.
The service had policies in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had been submitted. Registered nurses were able to describe in detail requirements of the legislation. There was no evidence that any recent training had been delivered to care staff.
The service was safe, clean and hygienic.
People who used the service and staff told us there were now sufficient numbers of suitably qualified staff on duty. The provider had recently increased the numbers of registered nurses on duty at any one time. This helped to ensure that people's needs were always met.
Recruitment practice was safe and thorough.
We found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to managing medication and quality assurance.
Is the service effective?
People's health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required.
Overall, people and their relatives said their care needs were being met.
Most relatives confirmed they were able to visit their loved ones at any time and speak in private. They felt welcomed by accommodating staff. One relative told us; 'We are encouraged to come at all times, we have been late at times but get an excellent greeting.'
Is the service caring?
People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'I think it is a good home, they can't do enough.' 'Staff are very caring and compassionate.' 'I feel my X's needs are being met.' 'Find it extremely clean and staff are very supportive.'
Overall people's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.
Is the service responsive?
People completed a range of activities inside the service regularly. The home employed an activities coordinator who organised daily activities and events.
People we spoke to were aware of the complaint procedure. One relative told us; 'They have responded to our complaints well'. People can therefore be assured that complaints would be investigated and action taken as necessary.
Is the service well-led?
The service worked well with other agencies and services to make sure people received their care in a joined up way. A visiting health care professional said 'Everything I have asked the home they have delivered on, I have no concerns.'
The service had limited quality assurance systems in place to monitor the quality of the service delivered. It was not clear to us that identified shortfalls were addressed promptly. We were concerned that as a result the quality of the service was not continuingly improving.
People who used the service and their relatives had not completed any recent quality assurance questionnaires. As a result we were concerned that shortfalls were not addressed effectively.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to quality assurance.
Comments made included: 'The care is fabulous. I cannot fault the staff at all. They look after 'X' very well; they can't do enough for my relative'. Another person's relative said; 'The staff are caring, kind and compassionate.' People we spoke with spoke highly of the staff and the care they received.
People told us they enjoyed the food and the social activities. The provider had a system in place to identify, monitor and manage risks to the health, welfare and safety of people who use services. People told us they were looked after by a motivated and well trained staff team. Staff told us they felt well supported.
We found that improvements had been made to concerns we identified at the last inspection, that the provider did not have an effective system to regularly assess and monitor the recording of medicines. We saw that there were quality assurance systems in place to assess the effectiveness of the care and support provided to people who used the service.
We observed that care was unhurried and that staff supported and encouraged people who used the service to make choices.
We asked people about the care they received and they told us: "They can't do enough for you." "Nothing is too much trouble if you need them they are there willing to help. "One person's relative told us; "I don't leave here feeling sad, I feel comfortable in the knowledge that my relative is looked after."
We asked if people felt safe and they told us: "I do feel safe here." "If I have any concerns I can speak to any of the staff and they will sort it out for me."
We found some shortfalls in the management of medicines which the manager told us she would address.
Our observations during the visit showed people's dignity and privacy needs were maintained. People said they knew how to raise a concern and felt confident it would be dealt with.
Some of the comments we received during our visit included:
'The girls are very nice, they bathe me and shower me and make my meals.' Staff understood people's needs and how they liked their care provided.
People were generally satisfied with the care they received and one person said 'The staff have spoken to me about my care and any treatment.'
People told us they liked the environment and some of the social activities provided. One person said, 'My bedroom is very nice. Sometimes they have a concert for us or we sometimes have bingo, I also like it when the artist comes in and sings for us.'
People told us they liked the food overall and were able to have some choice.
People felt any concerns they did have would be listened to and action would be taken to address them.