Archived: Kelstone Court Nursing Home

Kelstone Court provides accommodation and nursing care to up to 30 older people. At the time of our inspection 26 people were using the service.

At the time of our inspection a new manager was in post. They had been in post for four weeks and were in the process of applying to become the 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.

People were not always protected from risks to their health and safety. Environmental risk assessments had not been completed and the risks to people’s safety posed by the environment had not been considered or mitigated. Individual risks assessment were not regularly reviewed and adequate management plans were not in place to mitigate the risks, particularly in regards to the prevention of pressure ulcers, moving and handling and the prevention of falls.

Adequate assessments had not been undertaken to identify people’s needs and the support they required. Care plans did not contain sufficient information to ensure people’s care needs were met. Care plans were not updated in line with their changing needs, and did not provide accurate information about their current support needs.

Staff were aware of who was receiving end of life care, however, their care records had not been updated to reflect this. We also saw that advanced care plans were not updated, and there was a risk that people’s wishes and preferences had changed without this being captured and made available to staff.

There were insufficient processes in place to review and monitor the quality of service, including reviewing the quality of service delivery and ensuring accurate, complete and contemporaneous care records were maintained. Where the current processes had identified that improvements were required this had not always been actioned.

The environment was not being adequately maintained to ensure it was suitable to meet people’s needs. There were stains to walls and carpets, and peeling paintwork throughout the service. The provider informed us they were in the process of rolling out a redecoration programme, and we saw that this had been started.

There were sufficient staff deployed to meet people’s needs. There had been a high turnover of staff in the last year, and the manager was in the process of rebuilding the staff team. At the time of our inspection there was a reliance on agency staff, however, the manager ensured as much as possible that the same agency staff were used to maintain consistency in staffing.

Staff had the knowledge and skills to undertake their duties. They were required to complete training considered mandatory by the provider, and attend regular refresher courses. At the time of our inspection the staff were due to refresh their training, and we saw that courses had been booked. The new manager was also in the process of scheduling supervision sessions with staff to review their performance, and identify any support they required to undertake their duties.

Staff adhered to safeguarding adults procedures. They were able to describe signs of possible abuse and escalated any concerns observed to their managers and the local authority. Staff also adhered to the Mental Capacity Act 2005 and ensured people consented to the care and support provided. Where people did not have the capacity to consent, best interests’ decisions were made. The manager had organised for everyone with authorisation to be deprived of their liberty to be reviewed to ensure the restrictions were still appropriate.

Safe medicines management processes were in place and people received their medicines as prescribed. Staff were aware of people’s dietary requirements and liaised with healthcare specialists where they had concerns about people’s nutritional intake or swallowing. Staff organised for people to access healthcare professionals in order for their health needs to be met.

Staff were caring and interacted with people in a polite and friendly manner. They informed people about what support they wanted to deliver, and involved people in decisions about how they were cared for. Staff respected people’s privacy and dignity.

A range of activities were made available to engage and stimulate people. People had the opportunity to access individual and group activities, as well as accessing local amenities.

People and their relatives were aware of how to make a complaint. The complaints process had been updated to ensure it was in line with best practice and ensure people and their relatives knew they were able to complain to the home manager. People and their relatives were asked for their opinion about the service through the completion of annual satisfaction questionnaires.

Staff morale was improving and there was good team working. Staff felt able to access the manager and express their views and opinions. Staff felt any suggestions made were listened to. The manager was in the process of reintroducing a staff meeting to further obtain staff’s opinions and disseminate information about the changes the manager was making to improve and strengthen service delivery.

The provider was in breach of the legal requirements relating to person-centred care, safe care and treatment, suitability of premises and good governance. You can see what action we have asked the provider to take at the back of this report.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments had been carried out for each person and plans were put in place to minimise risks.

People who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards (DoLS).

Checks were undertaken before new staff began work. For example, the service carried out Disclosure and Barring Service (DBS) checks and followed up on people's references. Checks of nurse's registration status with the Nursing and Midwifery Council were also carried out.

However, the service did not always check staff qualifications by requesting copies of their course certificates. We also found that staff had not received all of the relevant training required to ensure they had the necessary skills to carry out their work. We have asked the provider to draw up an action plan to address these problems. We will go back to the service to check that these actions have been implemented.

Is the service effective?

Various audits were carried out to ensure the service was providing care effectively and in a suitable environment. For example, the manager had checked that the equipment used had been properly maintained and issued with the relevant safety certificates.

People's diversity and values were respected. The staff we spoke with were aware of the different cultural needs of the people using the service. Staff respected people's human rights and privacy. Staff knocked on people's door before entering their rooms. People could request care from staff of a particular gender.

Is the service caring?

We spoke with four people who were using the service. They were mostly satisfied with the care being provided. One person told us, "I am very happy to be staying here. The staff are great. The surroundings are usable and good." Another person said, "I like everything. They take good care of us. I was staying somewhere else before. This place is better."

We spoke with a relative of someone who was using the service. They were pleased with the care provided by the service. They told us, "Everything seems to be as it should be. The staff are polite and sociable. My wife is quite happy here. She would tell me if there was anything going wrong."

Is the service responsive?

The service actively sought additional advice from other health or care professionals if they observed any deterioration in the physical or mental health of the people using the service. These actions led to changes in the care plans, which the staff then implemented.

We examined how the service responded to complaints and what actions they took in response to accidents involving people who used the service. The service responded to concerns promptly and carried out investigations in relation to any accidents. Actions were taken to prevent accidents from happening again.

Is the service well led?

The provider had recently appointed a new manager at the service. The manager had been in post since July 2014. They were currently applying to become the registered manager with the Care Quality Commission (CQC). The manager had implemented some changes to the way the service was being run. For example, changes had been made to how the care plans were recorded.

The provider had effective systems to regularly assess and monitor the quality of service that people received. This included obtaining feedback from people using the service, their relatives, and members of staff.

The provider had written policies, including those relating to safeguarding and whistleblowing. The manager had recently reviewed and updated these policies.

We saw that people enjoyed their meals. They were always offered a menu choice and staff were able to identify anyone who was at risk of malnutrition or dehydration. The chef was able to cater for special diets or any individual preferences.

Medication procedures ensured that medication was handled appropriately and that people received their medication as it had been prescribed by their doctor.

The training records that we received showed that staff training was on-going. Regular staff supervision was in place to ensure that any shortfalls in training or individual training needs were highlighted.

Records that the service was required to keep, as evidence of its commitment to the welfare and health and safety of people, were well organised, maintained and held securely.

We observed staff encouraging people to maintain their independence for example by supporting them to walk and providing people with appropriate equipment to enable them to eat their lunch independently. We observed lunchtime at the home and saw positive interactions between people living in the home and staff. People told us that staff treated them kindly and one person said, "they are looking after me very well".

The home was warm, clean and well maintained. The home provided a range of double and single bedrooms and there was a communal lounge and dining area that people could use. There were adequate bathroom facilities for people to use that had been appropriately adapted to meet people's needs.

There were adequate numbers of staff on duty to meet people's needs effectively.

There was an effective complaints system in place and people's concerns were listened to and responded to promptly.