Background to this inspection
Updated
27 August 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors, a Specialist Advisor, and an Expert by Experience.
An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Green Hays and Kemp Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We contacted the local authority safeguarding team for feedback. We used all of this information to formulate our ‘planning tool’ and plan our inspection.
During the inspection
We spoke with two people who used the service and 10 relatives about their experience of the care provided. We spoke with 11 members of staff including the registered manager, clinical lead, senior care workers and domestic staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included nine people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
27 August 2021
About the service
Green Heys and Kemp Lodge is a residential care home which provides accommodation and nursing care for up to 75 people. The care was provided in two separate buildings, however, only one building was being used at the time of our inspection. Some people who resided at the home were living with dementia. At the time of our inspection there were 29 people living at the home.
People’s experience of using this service and what we found
Records in relation to people’s needs were not always completed accurately. Food and fluid charts did not specify how much food and fluid people had consumed which put some people at risk of unsafe care. Risk assessments in relation to bedrails did not thoroughly record or explore the risks posed to some people. This risk has now been mitigated, and the registered manager has assured us records relating to risk assessments have been completed in more detail for those needing it. Food and fluid charts have been re-organised to contain more detailed information to manage people’s risks safely.
People were not supported to have maximum choice and control of their lives and staff did not 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. This was because people had bedrails in place without the appropriate assessments and some people's ability to make choices were not always clearly assessed.
Quality assurance procedures were in place, and audits took place in a range of areas. However, there were gaps in the quality assurance process as the issues we identified during our inspection were not picked up.
We have made a recommendation with regards to staff engagement and support. This is because most of the staff we spoke with told us they felt unsupported in their roles and this impacted the care they gave. Supervisions took place, however more than three members of staff told us they felt the management in the home did not always address issues and staff morale was low. We highlighted this feedback to the registered manager and provider and were assured action would be taken immediately following our inspection.
Medication was well managed, and for people requiring medication as and when required (PRN) there were clear protocols in place for staff to follow. People’s clinical needs in relation to wound care and pressure area care were well recorded. Staff were recruited safely. We received some mixed feedback regarding staffing levels which we shared with the registered provider.
The home was clean and well maintained. Infection control arrangements were in place to prevent and mitigate the risk of COVID-19. Appropriate protective and personal equipment (PPE) was in place and care staff used this appropriately. The environment was suitable for people living with dementia.
Staff were trained in mandatory subjects relating to their role and had had an induction. We received mixed feedback regarding the food and menu choice at the home. However, the registered provider assured us following our inspection this was in the process of being changed following consultation with people.
Relatives told us they felt the staff were kind and caring, some comments included; “Staff seem very nice” and “I think the staff are quite nice”. We observed staff knocking on people’s doors and speaking to people with respect and curtesy during our inspection.
The registered manger understood their role and had sent all required notifications CQC in line with regulatory requirements.
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 the service under the previous provider was Requires Improvement published on 11 December 2019.
Why we inspected
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.
The inspection was prompted in part due to concerns received about people’s weight and pressure area care. A decision was made for us to inspect and examine those risks.
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 registered provider took immediate action to mitigate risks. They have updated us with regard to the action they have taken.
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.
We have identified breaches in relation to record keeping and governance and the application of the Mental Capacity Act.
Please see the action we have told the provider to take at the end of this report.
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.