Archived: Keresley Wood Care Centre

Keresley Wood Care Centre is a care home which provides nursing and personal care for up to 47 older people. At the time of our visit 28 people lived at the home. Accommodation is provided in a two-storey adapted building.

People’s experience of using this service and what we found

This is the sixth consecutive inspection where the provider has failed to achieve the minimum expected rating of good.

The provider had failed to take action to meet regulatory requirements and to improve to the service people received. We found there continued to be a lack of effective governance, provider and management oversight at the home. The home did not have a registered manager and the provider had failed to ensure staff had the leadership and management support they needed to fulfil their roles effectively. Quality monitoring systems and process continued to be ineffective. This demonstrated lessons had not been learnt since our last inspection.

People and relatives told us low staffing levels and the increased use of agency staff continued to impact negatively on people’s experiences. This meant people did not receive consistent good quality, safe care. The provider continued to fail to manage and mitigate risks associated with people’s care. However, people told us they felt safe. The management of people’s medicine had improved.

Most staff were recruited safely. Staff received an induction when they started working at the home and completed on-going training. However, the induction for agency staff was not effective and people and relatives did not have confidence in the knowledge and skills of agency staff.

People were not 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.

People and relatives spoke fondly of the permanent staff who provided their care and support. Permanent staff understood the needs of the people they supported. People’s privacy was respected. However, some people’s dignity was compromised and their independence was not promoted. People were encouraged to maintain important relationships and had access to a health and social care professional when needed.

People’s care was not always provided in line with their needs and preferences. People’s care plans contained the information staff needed to provide personalised care. However, staff did not always have the time they needed to read people’s care plans. The completion of supplementary records continued to require improvement to demonstrate people had received their care and support safely and as planned. People had opportunities to engage in meaningful activities. Complaints were not well-managed.

Despite our findings, people and relatives told us they were happy with the care provided but were dissatisfied with the way the home was being managed.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 May 2019) and there were three breaches of the regulations.

Following our last inspection, a condition was placed on the provider's registration for them to submit weekly reports to us to show actions taken to improve the service. We had not received all of these reports. During this inspection we found some of the weekly reports we had received contained inaccurate information regarding improvements made.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection, enough improvement had not been made and the provider continued to be in breach of three regulations. The breaches related to risk management, staffing levels and how the service is managed.

We are mindful of the impact of 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 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.

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 with the 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 now ‘Inadequate’ and the service 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.

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

People’s experience of using this service:

•There were not enough staff on duty to ensure the delivery of safe care in line with people’s assessed needs.

•Managerial oversight of the service did not support continuous improvement or ensure people received safe individualised care.

•People felt safe but risks associated with people’s care were not well-managed.

•Systems to monitor the quality and safety of the service were not effective.

•Lessons learnt when things had gone wrong had not always been clearly communicated to staff.

•Medicines were not always managed safely.

•The environment was clean, and staff followed good infection control practices.

•People’s dignity was not maintained. Staff respected people’s privacy and supported people to be independent.

•Staff were recruited safely and received on-going support and training to be effective in their roles.

• People had individualised care plans. However, some did not contain clear information. Daily records were not accurate and did not assure us people received care in accordance with their needs and wishes.

•People’s needs had been assessed before they moved into the home to make sure it was the right place for them to live. People and relatives were involved in planning and reviewing care.

•People received information about the service in a way they could understand and had some control over how to live their lives.

•Staff had a good knowledge of people’s dietary needs. People enjoyed their meals, and their dietary needs were catered for. However, the meal time experience was not positive.

•Staff cared about people but did not have time to provide person centred care.

•Activities were provided but improvement was needed to ensure people were not socially isolated.

•People received timely support from healthcare professionals.

•People, relatives and staff were encouraged to share their views about the service. Some feedback was used to drive improvement.

•People, relatives and staff spoke positively about the registered manager.

•Complaints were not managed in line with the provider’s procedure.

Following our inspection, we notified relevant stakeholders such as the Local Authority Quality Team about the areas of concern we identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 – Staffing.

Rating at last inspection: At the last inspection the service was rated as ‘Requires Improvement’ (The last report was published 20 April 2018).

This is the fourth consecutive time the service has been rated ‘Requires Improvement’.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Keresley Wood Care Centre is a ‘care home' with nursing. 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 home provides nursing care to a maximum of 44 people. Sixteen people lived at the home on the day of our inspection.

The home operates on two floors. The ground floor accommodation consists of a lounge, a dining room, a larger lounge and dining room, and bedrooms. The first floor has bedrooms only.

The home had a registered manager. 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 registered manager had worked for the service for four months at the time of our inspection visit.

We last inspected the home on 22 March 2017. The home was rated as ‘requires improvement'. Since our inspection in March 2017, the home had been through another period of instability. The manager and deputy manager present at our last inspection left the service, as did a high number of staff. This meant the improvements made at our last inspection were not sustained, and there was a further dip in the quality of care people experienced. The provider worked with the commissioners of the service and with the CQC in providing information about how they were managing and improving the situation.

A new registered manager and deputy manager were now in post. We received positive comments about their management style, and saw stability was returning to the home, with relatives becoming more confident they would address any concerns raised; and staff feeling more supported.

Whilst there had been a high level of staff vacancies since our last inspection, and therefore a high level of agency staff usage; at the time of our visit this was significantly decreasing, and the home was beginning to enter a more stable period. There were sufficient staff on duty to meet people's needs.

There had been concerns since our last visit that risks to some people's health and well-being had not been managed well. The new management team had worked hard to improve risk assessments and to monitor and act on identified risks.

New and existing staff had received training to support their roles and responsibilities. Newly recruited mental health nurses were in the process of receiving training to improve their responsiveness with general nursing needs.

People had access to other healthcare professionals when required. Medicines were managed safely and people received their medicines when they should.

The clinical support provided to people had improved, but the home was less responsive in providing social and emotional support to people. Activities were provided but these did not seem to reflect people's interest or hobbies.

The registered manager was open to listening to concerns or complaints about the service and responded to individual complaints in accordance with the provider's policy and procedures. People had the opportunity to discuss their views at monthly resident and relatives meetings.

People enjoyed their meals. People at risk of malnutrition and dehydration were provided with sufficient support to reduce this risk.

Staff were kind and caring to people, and had a desire to make sure people received good care. They respected people's dignity and privacy.

The provider recognised the importance of respecting people's human rights, and the promotion of equality and diversity in the home. The registered manager and staff understood and complied with the Mental Capacity Act regulations and Deprivation of Liberty safeguards.

The provider and registered manager understood their responsibilities to safeguard people from harm, and took action when required to support people's safety. Recruitment practice minimised the risk of employing staff unsuitable to work in the care sector.

The home was clean and well-maintained. Safety checks on fire, electric, water and gas systems had taken place, and staff understood the importance of infection control. The provider had redecorated and refurbished the home.

The provider, registered manager and their management team had worked hard to improve the service. They had made a good start. They needed to ensure the improvements made would be sustained over time and when a higher number of people used the service.

Keresley Wood Care Centre is a nursing home which provides nursing care to a maximum of 44 people. 19 people lived at the home on the day of our inspection. The home operates on two floors. The ground floor accommodation consists of a lounge, a dining room, a larger lounge/dining room and bedrooms. The first floor has bedrooms only.

At the time of our visit the home did not have a registered manager. The previous registered manager resigned in October 2016. 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 manager subsequently registered with the CQC in June 2017.

At our last inspection visit in May 2016 we found that the provider was not meeting the required standards. We identified two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was not enough staff to meet people’s needs and that care delivered was not person centred.

Following our last inspection we asked the provider to send us an action plan outlining the improvements they intended to make. At this inspection we found improvements had been made however one care plan did not reflect changes in a person’s care needs. The manager addressed this during our inspection visit.

People who lived at Keresley Wood Care Centre and the staff who supported them, thought people who lived at the home were safe. There were systems and processes in place to protect people from the risk of harm.

We observed, and people told us, staff members were caring and however we received mixed opinions about if staff had enough time to spend with people that was not task focused.. People had access to call bells and these were responded to promptly by staff.

Staff received training the provider considered essential which provided them with the skills and knowledge to provide effective care to people. Staff understood how to support people who did not have capacity to make decisions for themselves and relatives were involved in this process.

People received a choice of food and drink which met their nutritional needs. We saw staff supported people to eat and drink and we saw people were offered drinks throughout the day. Records related to people’s food and fluid intake were in place in order to ensure their health and well-being were being maintained.

People were supported to maintain good health. We saw some appropriate referrals were made to specialist healthcare professionals when people needed support, for example with eating and drinking and promoting good skin care.

Care plans and risk assessments contained information that supported staff to meet people’s needs. People and their relatives were not consistently involved in reviewing the care that was provided.

Staff treated people with kindness and respected their dignity . Most people were happy about the activities available in the home however the manager acknowledged they could be better tailored to individual interests, especially for people who were cared for in bed. The manager was reviewing the activities offered by the home to improve this.

People and relatives were encouraged to share their views about the home and people were aware of how to make complaints. When a complaint was received the manager investigated it in line with the home’s complaints procedure.

Staff felt supported by the manager and felt the provider had invested a lot of time into helping the home improve however this had been limited by a number of changes in managers.

Keresley Wood Care Centre is a nursing home which provides nursing care to a maximum of 44 people. Forty three people lived at the home on the day of our inspection. The home operates on two floors. The ground floor accommodation consists of a lounge, a dining room, a larger lounge/dining room and bedrooms. The first floor has bedrooms only.

The home has a registered manager. 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. We refer to them as the manager throughout this report.

At our last inspection visit in January 2015 we found the registered manager had not sent all statutory notifications required to us and this was a breach of regulation. These were notifications to inform us of deaths and incidents that affect the health, safety and welfare of people who live at the home.

Following our last inspection we asked the provider to send us an action plan outlining the improvements they intended to make. At this inspection we found improvements had been made however two notifications we received were not completed in detail and referrals to the local safeguarding authority were not made. The provider had addressed this prior to our inspection visit.

People who lived at Keresley Wood Care Centre and the staff who supported them, thought people who lived at the home were safe. There were systems and processes in place to protect people from the risk of harm. However, everyone we spoke to at the home told us there were insufficient numbers of care staff to provide care and support to people at the times they needed it.

Some people and relatives were unhappy with the care provided and expressed concerns about the length of time they, or their relations, had to wait to receive care. Staff were committed to providing a good standard of care but we observed there were delays in attending to the personal care needs of people. People did not consistently receive baths and showers when they wanted them and there were delays in people being assisted to use the toilet.

We observed, and people told us, staff members were caring but did not have time to interact with people unless they were providing personal care and we saw some people were left for long periods with little interaction. Call bells were not always in people’s reach when they needed to request support from staff.

Staff did not consistently receive support from the provider and manager to enable them to provide effective care to people. Only 50% of staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place to ensure that people who could not make decisions were protected, however we found appropriate assessments had not always been completed in detail. This was being addressed by the provider and training was taking place on the day of our inspection.

We saw people received a good choice of food and drink, and people’s nutritional needs were met. We saw that staff supported people to eat and drink, however some people told us drinks were not always available when they wanted them. Records related to people’s food and fluid intake were not in place in order to ensure their health and well-being were being maintained.

People’s health needs were met. We saw some appropriate referrals were made to specialist healthcare professionals where people needed support, for example with eating and drinking and skin breakdown.

Care plans and risk assessments contained information that supported staff to meet people’s needs. However some had not been updated when there had been change in people’s care needs and some initial assessments of people’s individual needs were not completed in detail. There was a risk that staff would not have up to date information on risks to people and how to keep them safe. People and their relatives were not consistently involved in the planning of care being provided.

Records did not always reflect the care and support people required or received. Some wound care charts did not contain sufficient information on pain management and people’s daily records were not completed accurately to show they had received personal care.

Staff treated people with kindness. Staff had a good understanding of people’s needs and most supported people with respect, however some people told us staff did not consistently ensure their dignity was maintained at all times.

The provider employed an activity worker to support people with their activities, hobbies and interests. However we saw they were often involved in other duties around the home which reduced the time they were able to spend supporting people.

Staff felt supported by the registered manager but did not feel the provider was supportive.

The provider had recruited a new area manager to support the registered manager. They were both open and transparent about the improvements that needed to be made in the home and the provider had taken immediate action to address the issues we highlighted.

We found a number of 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 the report.

People we spoke with told us they liked living at Keresley Wood. They told us staff were kind, and treated them with respect and dignity. One person told us, 'Everyone is friendly'they'll sit and listen'. This was echoed by a relative who said, 'It's great. The staff are so friendly'we've nothing but praise'.

We looked at care and consent to treatment. We saw that good care was provided. People and their families were fully involved in the decisions made about the way care was provided.

We looked at how the service recruited its staff. We saw that recruitment practice ensured staff were appropriately qualified and were safe to work with people living at Keresley Wood.

Staff told us they enjoyed working at Keresley Wood. One staff member said, 'Everyone is brilliant, the company have supported me to do the job well'.

We looked at the administration of medicines at the home. We were satisfied that medicines were administered safely.