Archived: Kemp Lodge Care Home

Kemp Lodge is registered to provide nursing and personal care for up to 38 people. At the time of the inspection there were 15 people living at the service. A large proportion of people had already left the service or were in the process of moving to alternative accommodation. Kemp Lodge is a purpose built single story building consisting of three units and provides care to adults with nursing and personal care needs. The service is set in pleasant grounds in a residential suburb of Liverpool.

Kemp Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection a registered manager was in post. A registered manager is a person who has registered with CQC 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 inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because at the last inspection, the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating for this inspection.

This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 12 December 2018 had been made, when the service was rated as ‘Requires Improvement.’ This is because breaches of legal requirements were found in relation to ‘Safe Care and Treatment,’ ‘Safeguarding’ and ‘Good Governance,’ which are breaches of Regulation 12, 13 and 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Services rated as ‘Requires Improvement’ will be inspected again with 12 months. Prior to our inspection in December 2018, the registered provider had applied to CQC to remove the location and the service was due to close in February 2019. However, the provider had recently extended the date for closure until June 2019. Given that the service was due to remain open later than originally planned, we decided to conduct a focused inspection. We needed to consider any current risks and how the provider has mitigated them appropriately and the impact on people using services and whether the provider remains in breach of requirements.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led. At this inspection, we checked to see whether the provider had acted on our findings from the last inspection and what action had been taken to resolve them.

When we completed our previous inspection, we found concerns relating to ‘Safe care and treatment’ and ‘Good governance.’ This was because systems in place to manage topical medication, thickening agent and PRN medication (as and when required medication) were not being properly managed and systems to manage the quality and safety of the service were not always effective. This was a breach of Regulation 12 and 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014.

At the last inspection, we looked at safeguarding records and found that the service did not always appropriately identify safeguarding concerns and notify us of concerns. This meant people were exposed to the risk of actual or potential harm. This was a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities Regulations) 2014.

During this inspection we found that although a number of improvements had been made, the registered provider still remained in breach of ‘Safe Care and Treatment,’ ‘Safeguarding’ and ‘Good Governance.’ To improve the rating from ‘Requires Improvement’ the service requires a longer-term track record of consistent safe practice and sustainability of governance.

We looked at care records belonging to four people. We saw that people’s care requirements were identified and people were appropriately referred to external health professionals when required. This helped to maintain people’s health and well-being. However, we also found that care plans did not always consistently record the most up to date information throughout. This meant that people were at risk of not receiving the care and support they required.

During our inspection we found a number of fire doors did not close properly and some fire doors and exits had been wedged open. This meant they would be ineffective in the event of a fire and placed people at risk.

Most people we spoke with told us they felt safe living at Kemp Lodge. Staff understood their responsibilities in relation to safeguarding people from abuse and mistreatment and could explain how they would report any concerns.

We looked at how accidents and incidents were reported in the service and found they were managed appropriately. Accident/incident reports were monitored by the registered manager and regional manager for any trends or patterns.

We found there were enough staff on duty to meet people’s needs. Some people using the service had fed back to management that they didn’t always feel there was enough staff on duty. The service responded by increasing staff numbers.

Feedback about the current registered manager of the service was positive. There were a range of comprehensive audits in place which identified issues and recorded action taken to resolve them. However, action had not yet been implemented to address the repeated concerns we found during our inspection in relation to consistency of information contained in people's care records.

The ratings from the previous inspection were displayed prominently as required.

Kemp Lodge is registered to provide nursing and personal care for up to 38 people. At the time of the inspection there were 20 people living at the service. The registered provider had recently applied to CQC to remove the location and the service was due to close in February 2019. At the time of our inspection, a large proportion of people had already left the service or were in the process of moving to alternative accommodation.

Kemp Lodge is a purpose built single story building consisting of three units and provides care to adults with nursing and personal care needs. The service is set in pleasant grounds in a residential suburb of Liverpool.

Kemp Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection an assistant service manager was in post. This was because the registered manager had transferred to another service. A registered manager is a person who has registered with CQC 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.

At the previous comprehensive inspection which took place in December 2017, the service was rated as ‘Requires Improvement.’ We found the registered provider was not meeting legal requirements in relation to ‘Safe, care and treatment’ and ‘Good governance.’

At this inspection, we found the service continued to be in breach of ‘Safe, care and treatment’ and ‘Good governance’ which are breaches of Regulation 12 and 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014. This was because systems in place to manage topical medication, thickening agent and PRN medication (as and when required medication) were not being properly managed and systems to manage the quality and safety of the service were not always effective. We also identified a breach of Regulation 13 in relation to the management of safeguarding incidents.

We found that topical medicines were not always administered to people as prescribed. Topical medicines are medicines which are usually applied to the skin such as creams, gels and ointments.

We also found that the use of thickener in fluids was not recorded on people’s fluid input charts. Thickener is a prescribed product and is used to reduce the risk of choking for people with swallowing difficulties. This placed people at risk as records did not indicate the quantity of thickener people had received in their fluids.

We looked at the management of PRN medication. We found that for some people who were on PRN medication (such as pain relief), there was not always sufficient information recorded in their PRN protocols. This meant that people were at risk of not receiving medication when needed and in line with best practice.

We looked at daily charts and records and found that they had not been completed as rigorously as they should. Support was not being provided and did not follow guidance detailed in people’s plans of care. This meant that people were not receiving the care and support they required.

We looked at safeguarding records and found that the service did not always appropriately identify safeguarding concerns and notify CQC accordingly. This meant people were exposed to the risk of actual or potential harm.

We looked at systems to manage the quality and safety of the service and found they were not always effective. Although we saw evidence that the service carried out regular audits and had identified issues, it was not always recorded as to what action had been taken and by who. In some instances, action plans had not been implemented to say what actions would be completed and when. For example, some of the medication audits we looked at had highlighted issues but it was not clear from the audits as to whether action to address those issues had been undertaken. Audits had not always highlighted concerns we found during our inspection.

You can see what action we asked the provider to take at the back of the full version of this report.

Most people we spoke with and their relatives told us they felt safe living at Kemp Lodge. Staff understood their responsibilities in relation to safeguarding people from abuse and mistreatment and were able to explain how they would report any concerns. However, safeguarding concerns which had arisen in the service had not always been notified to CQC.

Arrangements were in place with external contractors to ensure the premises were kept safe.

We looked at how accidents and incidents were reported in the service and found they were managed appropriately.

We looked at recruitment processes which were in place. We reviewed personnel records for four members of staff. We saw that each staff member’s suitability to work at the service had been checked prior to employment to ensure that staff were suitable to work with vulnerable people.

We looked at care records belonging to four people. We saw that people’s care requirements were identified and people were appropriately referred to external health professionals when required. This helped to maintain people’s health and well-being.

People and their relatives were involved in the formulation of their care plans. We saw that people’s preferences were considered. Staff supported people in a person-centred and dignified way.

Staff sought consent from people before providing support. Staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA) to ensure people consented to the care they received. The MCA is legislation which protects the rights of people to make their own decisions. We noted that the service did not always carry out assessments when assessing people’s capacity to make specific decisions and that assessments focused on people’s general ability to consent. We discussed this with the assistant service manager.

We found there were enough staff on duty to meet people’s needs. Interactions we observed between staff and people living at the service were caring. Staff treated people with respect and took care to maintain people’s privacy and independence.

There was an open visiting policy for friends and family. For people who did not have anyone to represent them, the service supported them in finding an independent advocacy service to ensure that their views and wishes were considered.

The service used an external catering company to provide all meals. Staff we spoke to were knowledgeable about people’s dietary requirements. People told us they could have an alternative of their choice if they did not like what was on the menu.

The service had a complaints procedure in place. Relatives told us they felt comfortable in raising any concerns or issues they had with the manager. Complaints were recorded and acted upon appropriately.

We found the environment to be clean and spacious, this made it easy for people to navigate around.

People could decorate their own room for example, by bringing in items of their own furniture or bedding.

Feedback about the current manager of the service was positive.

Kemp Lodge is a large care home, registered to provide general nursing and personal care for up to 38 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection there were 22 people living at the home. The home is a purpose built facility with all accommodation located on the ground floor. There were well maintained gardens to the rear of the building and a number of car parking spaces at the front.

At the time of the inspection there was a registered manager in post. 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.

At the previous comprehensive inspection which took place in May 2017, the home was rated as ‘Inadequate’ and placed in ‘Special Measures’. We found the registered provider was not meeting legal requirements in relation to safe care and treatment, need for consent, receiving and acting on complaints, good governance and staffing.

Services in 'Special Measures' are kept under review and inspected again within six months. The expectation is that providers who have been providing ‘Inadequate’ care should have made significant improvements within this timeframe. If not enough improvements are made and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

Following the previous inspection the registered provider submitted a number of action plans which outlined how they were improving the standards of care and quality of service. During this inspection we checked to make sure that the provider had made enough improvements to meet their legal requirements.

During this inspection we found a number of improvements had been made however the registered provider was found to be in breach of ‘Good Governance’ and ‘Safe care and Treatment’.

We reviewed a number of care records for the people who lived at Kemp Lodge and found that care plans and risk assessments were being regularly reviewed however there was still some inconsistent information found in different assessments and clinical processes were not being completely adhered to. This meant that the delivery of the care being provided was not always being safely monitored or reviewed, meaning that people were exposed to unnecessary risk.

Medication processes and systems had generally improved although we did identify some examples where further improvements needed to be made. Prescribed medicated creams were not always being applied as staff had been instructed. This meant that people were not always receiving a safe level of care in relation to the medications which they were being prescribed.

During this inspection, we did identify improvements which had been made in relation to the overall governance of the service although it was still evident that further systems and processes needed to be implemented and maintained in order to improve the standard and delivery of care which was being provided.

You can see what action we have told the registered provider to take at the back of the full version of the report.

There was an activities co-ordinator in post at the time of the inspection. The activities co-ordinator was responsible for organising a range of different activities for residents to involve themselves in. The feedback we received about the range of different activities from both relatives and residents was mixed.

We have made a recommendation to the registered provider in relation to the activities which are arranged.

There was evidence to suggest that that the service was operating in line with the principles of the Mental Capacity Act, 2005 (MCA). This was because people were involved in the decisions taken in relation to their care and treatment and there was best interest processes in place for people who lacked capacity.

During this inspection we found that processes had improved in relation to acting on and receiving complaints. The complaints process was visible and available for people and visitors to familiarise themselves with. People were aware of the processes and knew how to make a complaint and the registered manager was responsive to any complaints and feedback which they received.

During the inspection we found that the area of ‘staffing’ had improved. Routine supervisions and appraisals were taking place, staff were receiving the necessary training to enable them to fulfil their roles to their full potential and staff expressed that they felt supported on a daily basis.

We found the environment to be clean, well maintained and free from any odour. There were effective cleaning rotas and health and safety audits in place as well as there being evidence to suggest that infection control policies were being adhered to. This meant that people were living in a safe and well maintained environment.

During this inspection we found that care records were personalised, staff were able to provide person centred care and people expressed that they were supported with their likes and preferences.

We reviewed recruitment processes and found that this was being safely and effectively managed within the home. This meant that all staff working at the home had suitable and sufficient references and the appropriate criminal record checks had been conducted.

Accidents and incidents were being recorded and the registered manager was analysing and assessing the data on a monthly basis. The process and systems which were in place to assess and monitor accidents and incidents enabled the registered manager to analyse if changes needed to be made within the home and if further risks needed to be mitigated.

The day to day support needs of people living in the home were being met. The appropriate referrals were taking place when needed and the relevant guidance and advice which was provided by professionals was being followed accordingly.

People told us that their privacy and dignity was always respected. Staff were able to provide examples of how they ensured privacy and dignity was maintained as well as describing how people’s choices and preferences were supported.

Staff were observed providing compassionate care and engaging with people in a sincere and friendly manner. There was a positive atmosphere throughout the course of the inspection and it was evident throughout the inspection that staff were familiar with the people they were supporting.

The service had developed a working relationship with external caterers in the summer of 2017. Caterers were able to deliver food based on people's choices, likes, preferences and dietary needs. People had a choice of different foods and there was evidence to suggest that ‘menu options’ were discussed in ‘resident’ and ‘relative’ meetings.

The registered manager was aware of their responsibilities and had notified the CQC of events and incidents that occurred in the home in accordance with the CQC’s statutory notifications procedures. The registered provider ensured that the ratings from the previous inspection were on display within the home as well as being displayed on the provider's website.

We reviewed the range of policies and procedures which were in place. Policies we reviewed included safeguarding adults, equality and diversity, confidentiality, whistleblowing, infection prevention control and medication administration policies. Policies and procedures were available to all staff and they were able to discuss specific procedures and processes with us during the inspection.

Kemp Lodge is a large care home, registered to provide general nursing and personal care for up to 38 people. At the time of the inspection there were 27 people living at the home. The home is a purpose built facility with all accommodation located on the ground floor. There were well maintained gardens to the rear of the building and a number of car parking spaces at the front of the home.

At the time of the inspection there was no registered manager in post. 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.

At the previous comprehensive inspection which took place in November, 2014 the home was rated ‘Good’ across all areas. During this inspection we found a number of concerns and identified a number of breaches in regulation. These included Regulation 11 ‘The need for consent’, Regulation 12 ‘Safe care and treatment’, Regulation 16 ‘Receiving and Acting on complaints’, Regulation 17 ‘Good Governance’ and Regulation 18 ‘Staffing’. During the inspection we found that people’s safety was being compromised in a number of areas.

We found that assessments and care planning for some people had not been updated and implemented to ensure care was safe and reflected people’s changing needs. The risk of not updating major changes to people’s care plans is that new staff might be unaware of their changed care needs and there is an increased risk that specific areas of care might not be effectively monitored and reviewed, exposing people to unnecessary risk.

We found that there was a lack of support for staff to fully develop their skills and knowledge to effectively and safely manage aspects of both personal and clinical care.

Staff were not always familiar with the support needs of the people they were caring for. There was often conflicting information being provided in care records and there was no consistency with the care being provided.

Accidents and incidents were routinely recorded on an internal database system however there was little evidence to suggest they were being communicated amongst the staff team. Not all staff were made aware that accidents and incidents that had occurred and ‘lessons learnt’ from analysing the accidents/incident information was not being shared with staff to improve practice.

The concerns we identified are being followed up and we will report on any action when it is completed.

There was little evidence to suggest the home was operating in line with the principles of the Mental Capacity Act, 2005 (MCA) Mental capacity assessments were completed, though they were not always completed accurately. Best interest did not clearly reflect that relevant people had been involved in making those decisions. People’s consent was not always gained in line with the principles of the MCA.

You can see what action we took at the back of this report.

People’s day to day support needs were not being met. External healthcare professional referrals were not taking place when requested and guidance and advice which was provided by external health professionals was not being acted on. Care records contained conflicting information and staff were not always following the most up to date healthcare reviews.

During the inspection a number of care records were reviewed and it was evident that care plans were often pre-populated and were not individual to that person.

Staff morale appeared to be subdued due to number of recent changes in management. It was evident throughout the inspection that there was a divide in the staff team, communication was poor and the lack of consistent leadership and management was impacting on all areas of safe care and treatment.

There was a complaints policy in place and people knew how to make a complaint. There was evidence of the initial complaint being responded to however there was no evidence of any written outcomes being provided or any evidence of lessons being learnt from the complaints received.

The management of topical preparations such as cream was not managed safely in the home. Multiple creams were prescribed to people within the home but there was no evidence to indicate what creams had been applied, what part of the body the cream had been applied to and how many times throughout the day the cream had been applied.

During this inspection we found that audits and checks were being completed, however there was no system in place to monitor and assess when improvements and any actions which had been identified should be completed. This meant that the systems in place to make changes and drive the home forward were not effective.

People did feel that their privacy and dignity was respected and staff were able to provide examples of how they ensured privacy and dignity was maintained. Staff did express that they felt their jobs were ‘task-led’ and they ‘wished they had more time’ with those who lived at the home. The manager had expressed that the deployment of staff across the service needed to be properly assessed in order to ensure the level of support and care was being appropriately provided.

During the inspection a Short Observational Framework for Inspection tool (SOFI) was used. SOFI tool provides a framework to enhance observations during the inspection; it is a way of observing the care and support which is provided and helps to capture the experiences of people who lived at the home who could not express their experiences. Staff were seen to be attentive and offered kind and compassionate care.

A programme of activities was available for people living at the home to participate in. People were happy with the amount of activities offered in the home and relatives made positive comments regarding the range of activities which people could join in with.

There was a mixed response in relation to the quality and standard of food. Upon review, we found that the home had just developed a working relationship with external caterers who were going to be preparing and delivering food based on people's choices, preferences and dietary needs. Some people expressed how they had a choice of different foods, staff accommodated different needs, likes and preferences were catered for and dietary requests were supported.

Recruitment was safely and effectively managed within the home. Staff personnel files which were reviewed during the inspection demonstrated effective recruitment practices were in place. This meant that all staff who were working at the home had suitable and sufficient references and disclosure barring system checks (DBS) in place.

The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications. The provider ensured that the ratings from the previous inspection were on display within the home as well as being visible on the provider website, as required.

There were specific policies and procedures available to guide and support staff in their roles. Staff were aware of the such policies including the home's whistle blowing and safeguarding policy.

We are taking a number of appropriate actions to protect the people who are living in the home. The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by the CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in ‘special measures’ must be inspected again within six months. If insufficient improvements have been made we will take the necessary actions in line with our enforcement procedures which is to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We spent some time observing people in the dining area and could see there were sufficient numbers of staff present to assist people with their meals, if they required help. We asked one relative who was spending lunch time with their family member if they thought people had enough support when taking meals. This person told us "[Family member's name] only eats small amounts so I come down everyday to encourage [name] to eat. The staff wouldn't be able to spend as much time as I do, doing this. They do help, but I can come each day to do it."

We found that people who used mobility aids had access to this equipment. Where a person had been assessed for a walking frame, this had been ordered for the person and was labelled as belonging to them. When equipment was serviced or repaired, this was done by a specialist company.

We found that when a person was transferred to hospital, or attended a specialist clinic for consultation, all information about the person was made available to other clinicians without delay.

The home had systems in place to monitor the quality of service provided.

At the time of our visit, people were engaged in various activities and we observed staff caring for people in a warm, friendly and respectful manner.

People spoke well of the staff and the levels of care provided. A resident said "I am happy here; they take care of me and know how I like things done. My family can visit when they like which is good because they have to go to work." The relative of a resident we spoke with described the care as being "Very good...there are three girls who she is particularly fond of and who care for her - they are lovely and I get on well with them all."

We were also able to see evidence of improvements in response to comments or complaints from relatives of residents.

The home also took steps to make all communal spaces social spaces - e.g.the use of the wide corridors, by placing couches against walls, which encouraged residents to stop and chat with each other. Although the home was a busy place, everybody took the time to stop and talk to residents - this was true of cleaners, catering staff and managers, as well as the carers and nursing staff. The decor was bright and friendly and residents were free to move about as they wished. The people we spoke with said that they were happy with the care they received. When we spoke with relatives, they told us that they had confidence in the level of care provided and that their loved ones were well looked after.