About the service Kiwi House is a residential care home providing personal and nursing care to 78 younger and older people, some who may be living with dementia. There were 63 older people living at Kiwi House at the time of the inspection. The care home accommodates people across three separate floors, each of which has separated adapted facilities.
People’s experience of using this service and what we found
Systems did not always safeguard people from abuse. People were not always protected from avoidable harm and lessons were not always learnt when things went wrong. Medicines were not always managed in line with good practice. Sufficient staff were not always deployed to ensure people’s safety and staff training had not always led to competence. Procedures were in place to ensure risks from infection were reduced.
Policies and procedures were in place to help ensure the quality and safety of services however, these had not always been followed. Audits had not always identified shortfalls and led to improvements in the quality and safety of services. Records were not always accurate and up to date. Opportunities for continuous learning and improvement had been missed. Working in partnership with others had not always been effective.
Staffs’ knowledge and understanding on training and people’s healthcare needs was not regularly checked in supervision; some staff felt they lacked knowledge in areas of people’s healthcare needs. Referrals to other healthcare services had not always been made effectively. People’s care needs were assessed.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Care plans were personalised however, it was not clear how people were involved in reviewing these. People’s independence was promoted, and people felt respected by staff. People liked the staff team and felt they were kind.
Not all people had their preferences met and care plans did not show how they had been reviewed with people to ensure their preferences were still known. People’s communication needs had been assessed and met. People’s relationships and social interests were supported. People were able to enjoy and engage in meaningful activities. People had opportunities to be involved and improve the service. A complaints process was in place. People had the opportunity to discuss their end of life wishes.
The building was suitable for people living at the service and had been adapted to people’s needs. People enjoyed their meals and were monitored for any weight loss.
The provider demonstrated a duty of candour in their approach to complaints management. Checks on equipment and premises were in place to help reduce risks. The management team had acknowledged staff morale and were focussing on achieving good outcomes for staff and people.
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 30 December 2020)
Why we inspected
The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury and died. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.
The inspection was also prompted in part due to concerns received about falls management, staffing, medicines and management of the service. A decision was made for us to inspect an examine those risks.
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.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Following our inspection, the provider began to implement a range of actions designed to mitigate the risks found.
The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kiwi House on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified four breaches in relation to safe care and treatment, safeguarding, staffing and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
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.