Archived: Kenwith Castle Country House Care

Kenwith Castle Country House Care (Kenwith) is a residential care home providing support and personal care for up to 59 people. It also provides personal care to people living in their own cottages and bungalows within the grounds of the care home. At the time of the inspection there were 52 living in the residential home and two people receiving care within their own homes on site of the care home.

The care home is an adapted building with accommodation on two floors. There are extensive grounds with lakes. Within the grounds there are a number of self-contained and privately own bungalows and cottages. People living in these have access to care and support if they wish. Only two people were using this service for personal care at the time of the inspection.

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

People who lived in the care home and people who received a service of personal care within their own home were very positive about all aspects of the service. People were particularly complimentary about the cleanliness of the home, the quality of meals and snacks available and the range of activities and outings available to them.

People were at the heart of the service; their views and requests were fully considered and actioned.

The service were highly responsive to people’s needs and wishes and went the extra mile to ensure activities and outings were meaningful.

The leadership of the servcie was extremely effective, ensuring best practice was used. They also shared best practice, publishing articles and being involved in projects across agencies to achieve the best outcomes for people.

People were protected because the service had robust recruitment processes. They ensured staff had training in understanding abuse and risk assessing to keep people safe.

People were supported to have a balanced diet, enjoy exercise and keep healthy. Staff worked in conjunction with other healthcare professionals to achieve good health outcomes for people.

Staff were skilled at understanding people’s communication needs and this helped people to make their views known by various ways.

There were sufficient staff with the right skills and support to ensure people’s needs were met safely and effectively. Training was seen as key to ensuring a skilled workforce.

There were robust and highly effective quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided.

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.

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 February 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Kenwith Castle is registered to provide nursing and personal care for up to 59 older people. It is divided into two floors or units. One provides for people with nursing needs and the other provides care and support for people without nursing needs. At the time of this inspection there were 50 people living at the service.

There was a registered manager running the service who was supported by a deputy and team of nurses; senior care staff and administrators. 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 benefitted from a service which was extremely well run. The registered manager had worked at the service for over 11 years and showed a strong commitment to continuous improvement via training, support and learning from audits and feedback. The management approach was open and inclusive with people, relatives and staff all having a strong degree of confidence in the registered manager and her team. Effective quality monitoring systems were used to help drive up improvement and this included seeking the views of people, their relatives and staff.

There were enough staff with the right skills, training and support to meet the number and needs of people living at the service. Staff said they felt valued and were encouraged to contribute to how the service was run and how care and support was being delivered. Staff understood people’s needs and knew what their preferred routines and wishes were. This helped them to plan care in a person centred way.

People were supported to express their views and were involved in decision making about their care and were offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make as many decisions as possible. Staff confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, capacity relatives, friends and relevant professionals were involved in best interest decision making.

Medicines were well managed and kept secure. People received their medicines in a timely way and where errors were noted, staff acted quickly to ensure people were not at risk. People were offered pain relief and received their medicines on time.

People mattered and staff cared for people in a way which showed empathy, kindness and respect. People’s healthcare needs were well met and staff understood how to support people with changing healthcare needs.

People were supported to enjoy a healthy balanced diet. Mealtimes were seen as important events and staff ensured this was an unhurried and enjoyable part of people’s day.

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day first of our inspection there were 47 people living at Kenwith Castle Nursing and Residential Home. The summary is based on conversations with 14 people using the service, 14 staff supporting them, two people's families, three health care professionals, the registered manager, observation and records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe with regard to the health and personal care arrangements. People told us they were 'Perfectly satisfied with the care provided" and 'The standards are very high". Health care professionals told us they had confidence in the skills and abilities of staff. Regular staff at the home set high standards and worked hard to meet them. However, staff induction had not provided newer staff with confidence and did not extend to all the recognised standards within the care sector.

The service was not always safe because there was a gulf between what the management believed to be supportive management and the staff opinion they were unsupported. This had led to some information of concern not being investigated and dealt with. This included concerns around staffing arrangements and the opinion by several staff there was some unsafe care at the home. We have asked the provider to tell us what improvements they will make in relation to the support of staff, staff induction and the supervision of staff work.

The service was not always safe because of the staffing arrangements. Whilst the staffing numbers were calculated using a staffing tool this did not take into account sickness and the high number of temporary agency staff needed to meet staffing shortfalls. We saw that care and support was not always provided in a timely manner. For example, one person at a high risk of falls being left in a dining room in a wheelchair and trying to stand without help. We have asked the provider to tell us what improvements they will make in relation to the staffing arrangements at the home.

The service was not always safe because some records had not been completed within a reasonable timescale. This had the potential for mistakes to be made and care to be missed. We have asked the provider to tell us what improvements they will make in relation to record keeping at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The registered manager told us they had not needed to submit any DoLs applications. They had sought advice appropriately where they considered people may not have capacity to make important decisions about their health and safety.

Is the service caring?

People were supported by kind and attentive staff. The staff were caring because the interaction we observed was kind, respectful and made people happier and more relaxed. People were invited to attend some activities, given wine and cake. People recognised staff and smiled in response to their attention.

People's families were happy with the care provided. We were told 'Very comfortable. Everybody is kind. I've no complaints". We saw that people's comfort and wellbeing was promoted by staff who cared about them.

Is the service effective?

People's health and care needs were assessed with them, but the plan of how that care was to be provided was not always followed. Individual needs were not always taken into account, such as drink preferences, equipment being readily available and the desire to speak to a GP in private. We believe this was because staff were sometimes rushed in their work.

The service was effective in that expert advice was sought as required and health care was promoted. Examples were dietary advice, eye and dental care. People were satisfied with those arrangements.

Is the service well led?

The service had a quality assurance system but not all shortfalls were identified and addressed. The system did not systematically ensure that people using the service and staff were able to provide feedback in a timely manner. Whilst there was a structure of delegation at the home and the support of the provider, this has not translated to a staff team which felt valued and where issues were addressed. Whilst there were formal arrangements for people to feedback their views, some people still had issues which they wanted addressed. We have asked the provider to tell us how feedback about the service will be taken into account on a more regular basis.

People told us "No complaints"; "Staff are very pleasant", "I feel safe and looked after properly", "Satisfactory" and "On the whole there is continuity of care." There was some negative comment about the temperature of water for washing and one person's shower facility.

People received a high standard of personal and health care. Their needs were assessed, planned and known very well by the staff who attended them. There was a wide variety of activities available to people such as quizzes, outings and a weekly social evening at the home's bar.

There was a very wide choice of menu and a balanced and nutritious diet available to people. Dietary needs were well monitored and concerns followed up appropriately.

The home environment was pleasant, in good repair, safe and suitable for people's needs.

Training ensured that staff were skilled and competent in their work but their work was not formally supervised in relation to their responsibilities. This meant that the standards delivered could not be assured.

People's views were sought, complaints followed up, health and safety managed and the quality of the service under regular review.

We found that people were consulted and involved in decisions about their welfare and that the personal and health care they received met their individual needs and preferences. Care needs were assessed, planned and reviewed. The home was very proactive in listening to people and acting on their requests.

People were protected from abuse and the registered manager (matron) was very well known to people, who spoke highly of her. They said that any issue would be dealt with promptly. Two said, "I would take any concern to matron".

There had been staff reorganisation and there were a lot of temporary (agency) staff working at the home. Neither people using the service or regular staff found this to be a problem provided the agency staff knew the home adequately. The home was currently recruiting new permanent staff to meet the shortfalls. Staff received induction and ongoing training and people said that staff were competent.

There were good systems in place to ensure that people could influence their care and service and also to ensure health, welfare and safety at the home.