All inspections: Kent House - Care Quality Commission

We carried out this inspection on the 31 March and 5 May 2017. The inspection was unannounced.

At our last comprehensive inspection of 25 February 2016 Kent House was rated as requires improvement. At this inspection, although we found considerable improvements had been made there were still areas that required improvement. Improvements were still required in order to meet Regulations 12 and 17.

Kent House is registered to provide accommodation and support with personal care for up to 40 older people, some of whom have dementia. At this inspection there were 23 people using the service. Kent house is part of Gold Care Homes Limited which provides 20 care homes in England.

On the first day of our inspection on 31 March 2017 we found problems with needs assessments, access to GPs and district nurses and a failure to identify these matters and respond to them through the quality auditing process. Following the inspection the provider informed us they were to make a change to their legal entity. In order to check that action had been taken to address our concerns we carried out a second inspection visit before the legal entity had changed to check improvements. On the second day of the inspection we found that action had been taken to address the failings relating to needs assessments.

The service had not had a registered manager since February 2016. An application to register the current home manager had been submitted to the Care Quality Commission for registration along with the provider’s application to change their legal entity. The new legal entity will have a registered manager for the service. 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. It is condition of registration that a registered manager is in place at the home.

Whilst some improvements have been made to the registered provider's governance systems, we found processes for assessing and monitoring the quality of the service were not fully effective. The auditing system had not identified issues we found during this inspection.

We found medicines were not always managed safely. This related in the main for those people who had recently moved to the home.

Following our initial feedback to the home, on the second day of the inspection we saw that the home had started to make improvements.

We saw evidence the home had revised its procedures for admitting new people to the home. The revised procedure aimed to ensure there was a smooth transition when people moved to the home and that care was individually tailored. We saw evidence of this in two admissions that were carried out since our first visit.

The home had made progress in its bid to ensure there were robust local arrangements with members of the multi-disciplinary team, such as the GP, district nurses and pharmacist. This was necessary in order to ensure these services were accessed in a timely manner by people living at Kent House.

We identified improvements care and support of people who had recently moved to the home. Their needs had been fully assessed, planned for and met.

People’s risk assessments reflected their current needs. There were plans in place to mitigate these risks. Staff had clear instructions about the care people required.

Procedures for pressure sore prevention and management had been improved. People were being repositioned according to their tailored schedules.

We saw that the home had improved the practice of seeking consent. They adopted a practice that was in line with the Mental Capacity Act 2005.

The meals provided at the home were good. People were supported to make sure they had enough to eat and drink. Where people had special dietary requirements, this was supported to meet people’s needs.

People were treated with respect and kindness. Staff supported people wherever possible to make decisions and express their wishes and views.

We found two breaches of regulations. You can see what action we asked the provider to take at the back of the full version of this report

We carried out an unannounced comprehensive inspection of this service on 19, 20 and 24 August 2015. Breaches of legal requirements were found in relation to, identifying and monitoring risks to people; safe management of medicines, meeting people’s nutritional needs; supporting staff; person centred care and monitoring the quality of the service. We undertook enforcement action, and imposed conditions. These conditions required the provider to submit regular information to us as to how they were addressing these concerns. We also placed the service under special measures.

After the comprehensive inspection in August 2015, the provider wrote to us to say what they would do to meet legal requirements. We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements.

We carried out this inspection on 25 February 2016 in line with our special measures policy. We checked what progress had been made in respect of addressing the breaches identified at the August inspection and also carried out a comprehensive ratings inspection.

Kent House is part of Gold Care Homes Limited and provides accommodation and support with personal care for up to 40 older people, some of whom have dementia. At this inspection there were 25 people using the service.

The home did not have a registered manager in place at the time of this inspection. 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.

A relief manager had been appointed to temporarily manage the service. The relief manager had the experience and capability to run the service. Since the inspection the service notified us that a new manager had been appointed and had commenced work.

At this inspection we found considerable improvements had been made in each key question. However, we found the service to be requiring improvement in all four of the five questions. This is because although improvements had been carried out following our inspection, the provider needed to demonstrate a consistent track record of improvements. We will keep the service under review to check if the noted improvements are sustained.

People using the service said they felt safe and that staff treated them well. The conditions we had served had been fully complied with.

We saw that staff were being deployed more effectively. People told us they were kept safe. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Where agency staff were used, we saw the same staff were brought in so they knew people’s needs. The new manager told us the service would not be admitting new people until all the new staff had commenced work.

There were suitable recruitment procedures and required checks were undertaken before staff began work. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly.

Training had been organised for staff since our last inspection. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

We noted improvements in people`s care plans. The service was introducing new care plans, which were more person centred. The care plans detailed how people wished to be supported.

We saw improvements in the way the service supported people to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

We found that systems had been improved to ensure that people were offered their medicines as prescribed. Systems, processes and standard operating procedures around medicines had been improved to ensure they were reliable and appropriate to keep people safe.

The service was recruiting more staff and had offered positions to seven staff, who were due to commence work subject to completing an induction programme. The new permanent manager told they would not be admitting people until all the new staff had commenced work.

Staff felt the management team were approachable. They spoke about the improvements they had seen since our last inspection. Systems were in place to monitor the quality of the service provided and drive continuous improvement.

In view of the significant improvements made in each key question the home is no longer in special measures. The conditions imposed on its registration at the August 2015 inspection have also been lifted.

This inspection took place on 20, 21 & 24 August 2015 and was unannounced. At the time of the inspection the registered manager was on long term sick leave. She had been off since May 2015. 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 and associated Regulations about how the service is run.

The provider had notified us that arrangements had been put in place so that the deputy manager would be managing the home with support from the regional manager. We were informed the regional manager was going to spend at least two days per week at Kent House and also having daily contact with the service. At this inspection we found the provider had appointed a general manager.

Kent House is part of Gold Care Homes Limited and provides accommodation and support with personal care for up to 40 older people, some of whom have dementia. At this inspection there were 25 people using the service.

At our previous inspection of 9 and 10 November 2014 we had found eight breaches of legal requirements. We issued five warning notices. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the five warning notices. We carried out a focused inspection on 27 February 2015 to check that they had followed their plan and to confirm that they now met legal requirements. We found the provider had met the legal requirements of the warning notices served.

At this inspection we found the provider had not sustained the improvements we noted in the last inspection in February 2015. We found that people’s safety was being compromised in a number of ways. There were inadequate plans in place to assess and manage risks associated with medicines management; pressure ulcers, nutrition, falls and staff deployment.

Assessment plans of care for people who were at risk of pressure damage were not being followed. In some examples, the recording of pressure care was not accurate and did not always reflect the care people needed.

People were at risk of malnutrition and dehydration. Dietary assessment plans were not always followed. People were not always supported adequately to eat and drink enough to meet their needs. The recording of food and fluids was inaccurate. It was not always clear whether people were having enough to meet their needs.

People’s dependency levels were not always calculated correctly and as a result the provider could not demonstrate staff deployment always reflected the level of care needs and support required to safely meet people’s needs. We found that the deployment of staff required improvement.

Not all staff had received training relevant to people they cared for. For example, staff looking after people receiving end of life care had not received relevant training.

The standard of record keeping was not fit for purpose. We found in some examples that records had not been fully completed. Some care records did not accurately reflect the care being provided or required.

People did not receive care that was tailored to their needs. Staff were focused on tasks and working through these rather than providing care that responded to each individual person. We observed that staff were caring, kind and respectful towards people but we also observed that they were stretched because of work overload.

Staff told us they did not feel well supported or listened to, and morale at the service was low. The absence of an effective arrangement for supporting staff, either through supervision, appraisals or by other means, meant the management were not aware of issues of concern and therefore were not able to adopt plans to boost morale.

There were safeguarding and whistleblowing policies and procedures in place which provided guidance to report concerns. Staff had received training in safeguarding and whistleblowing to protect people from abuse and training records confirmed this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that where required, DoLS applications had been made and the service manager understood when an application should be made and how to submit one.

Overall, we found significant shortfalls in the care provided to people. We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. We will publish what action we have taken at a later date.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special Measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, the service will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

We carried out an unannounced comprehensive inspection of this service on 9 and 10 November 2014, at which eight breaches of legal requirements were found and we issued five warning notices. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the five warning notices. We undertook a focused inspection on 27 February 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to the five warning notices. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Kent House’ on our website at www.cqc.org.uk’.

Kent House provides accommodation and support with personal care for up to 36 older people, some of whom have dementia. There were 32 people living at the home at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 our focused inspection on the 27 February 2015, we found that the provider had followed their plan and legal requirements had been met.

At our last inspection we found that although the service had a quality assurance system, records seen by us showed that not all of the shortfalls identified had been addressed. At this inspection, we found the home had improved its systems to assure the quality of services they provided. The way the service was run had been regularly reviewed. Prompt action had been taken to improve the service or put right any shortfalls they had found.We saw that all incidents were recorded accurately and people’s care records had been updated following these incidents to ensure that the most up to date information was available to staff.

We saw the provider had appointed a regional manager and part of her role was to oversee and support the registered manager to make the necessary improvements to address breaches we identified in our previous inspection and to ensure these were sustained. Additionally, the organisation had appointed a quality and compliance officer, with a responsibility to support the home with quality monitoring.

We noted improvements in people`s care plans. All people had an individual care plan which set out their care needs. We found that planning and delivery of care was better at addressing people’s needs and ensuring their welfare and safety. Care plans had been reviewed and updated to ensure that they reflected the individual needs and preferences of people.

We found that systems had been improved to ensure that people were offered their medicines as prescribed. Medicines were securely stored and administered. We saw that people received the medicines they needed and staff followed clear procedures for the management of people’s medicines.

Staff rotas showed that there were enough staff on duty to meet people’s needs throughout the day. Since our last inspection, we saw that the senior management had carried out a staffing assessment to check staffing levels at the home. One of the issues identified was that staff were spending a lot of time carrying out cleaning duties, and therefore reducing the amount of time spent providing care. At this inspection we saw the provider had recruited extra cleaning staff and an extra care staff to cover during busy hours. This arrangement was subject to ongoing evaluations by the provider. We will be monitoring this to check the full impact of the intervention and also to verify if improvements are sustained.

We also saw that staff were being deployed more effectively. The provider had developed a checklist to monitor the completion of each care activity. We found staff followed this checklist when conducting regular checks. They had noted the time and signed the observation chart as well as documenting other relevant information in the appropriate charts, including the food and fluid intake charts.

The provider had started to carry out cleanliness and infection control audits to monitor standards of cleanliness in the home. The senior management and staff demonstrated that they understood their roles and responsibilities in relation to infection control and hygiene and had put in place an action plan to address areas requiring improvement. Schedules for cleaning were in place and we saw they were up to date.

Training had been organised for staff since our last inspection. Staff had received training in topics specific to the needs of the people living at the home. Staff told us they were receiving the training they needed to provide them with the skills and knowledge to care for people effectively, and we saw them putting this into practice when supporting people. We observed good practice in infection control and medicines management.

We did not cover all eight breaches at this inspection as we focused on the breaches which were subject to a warning notice. We will undertake another unannounced inspection to check on all outstanding legal breaches identified for this service.

Kent House is part of Gold Care Homes Limited and provides accommodation and support with personal care for up to 36 older people, some of whom have dementia. At this inspection there were 35 people using the service.

This was an unannounced inspection. The service was last inspected in March 2014, and was found to be meeting the regulations we inspected.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

The provider carried out audits to monitor the quality of the service but this did not lead to improvements in people’s care. Prior to this inspection, the provider had undertaken audits, including on accident and incidents, medicines, care plans and infection control but there were no improvements made after each audit cycle.

Care plans were not regularly updated to reflect people’s changing care needs so that people received care that was appropriate and safe.

We saw some people’s records about care, treatment and support were not clear, factual and accurate. This meant people’s care records were unreliable and exposed people to the risk of receiving the wrong care and treatment.

The provider failed to ensure people receiving care were protected against the risks associated with unsafe use and management of medicines. People did not always have their medicines at times they needed them, and in a safe way. There were no appropriate arrangements for recording, storage and safe administration of medicines.

There were no appropriate steps to ensure that there were sufficient numbers of suitably qualified, skilled and experienced staff at all times. People’s safety was at risk through the lack of supervision for those who were at high risk of falls, lack of procedure in place for last minute absences and staff shortages and the failure of the provider to assess the needs of people when determining the number of staff required on duty.

Staff did not always ensure that people were eating and drinking enough to keep them healthy.

People using the service were not protected against identifiable risks of acquiring infections by means of the effective operation of systems designed to assess the risk of and to prevent, detect and control the spread of infection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with four people who used the service individually, and attended a residents' meeting. As this was a visit to check that improvements we required after our previous visit had been made, we also spoke with seven members of staff. People who used the service told us that the service had improved recently. One person said "Staff are more relaxed now. They work very hard to take care of us but they do so very well. This is a very happy home".

We found that the provider had taken steps to ensure staff felt supported in their roles, through team meetings, supervision and appraisals. Staff told us they felt they were working well together as a team, and that support for staff had improved in the last three months.

Additional staff being called upon when people needed more support also had an impact on the service people received. Staff told us that flexibility in the rota meant they felt as though they were meeting people's needs more safely. One staff member said "We are busy, but rushing is bad for the residents and yourself. More staff means we have more time to see to people and make sure they are okay".

During our visit we attended a residents' meeting and spoke individually with five people who used the service. We received information from a relative, and spoke with five staff, the deputy manager and the Registered Manager. One person who used the service told us "They look after us well here, there are lots of activities". Another person said "Staff can take a long time to respond to call bells. This is especially problematic when I need to go to the toilet - I hope I don't have an accident". A relative told us "The staff are really pleasant and try their hardest, but they are just too overworked".

One staff member told us "I really enjoy my job, I want to treat people well and make sure they're okay, but sometimes I feel as though I can't meet their needs as we are too busy". Another staff member told us "I care for others as I would like to be cared for ' sometimes it is very difficult as there isn't enough time. If I had more time I could do a much better job, care for people more and get to know them better".

We found that people's needs were met, but that staff were not appropriately supported through regular supervision and review of their work. We saw that support staff were very busy, and that there was no flexibility in staffing to accommodate people's changing needs. We found that the provider followed legal requirements for obtaining consent from people and that nutrition and medication were appropriately managed.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. We saw the monthly analysis of falls that showed the cause of any falls in the home, and the result.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. We saw the results of surveys of people using the service, their relatives and staff that were complete during 2012. There was an analysis of the responses and action plans to address any concerns that were raised. The provider made regular monitoring visits to the home to assess the quality of the services that were provided. The provider completed a comprehensive audit of care practices, the environment and records three times a year.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

We spoke with seven people who use the service and a relative of a person. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

All the people we spoke with felt the staff respected their privacy and dignity. One person said 'I like the way I am spoken to it makes me feel closer to the girls who help me.' All of the people we spoke with felt they were well cared for. One person said 'nothing is too much trouble.' All the people we spoke with were able to choose how they spent their day. One person said 'I am always asked to join in the activities but it's not for me however they come and sit with me and chat about what is going on in the world which I enjoy.'

Although people who use the service did say there was some choice of food and drink, one person found the food 'boring' and another said 'it's always sandwiches never rolls and I do like a ham roll.'

All the people we spoke with knew they could raise any concerns they had with the staff. One person said 'I'd speak out if I thought someone else needed help, I would not only worry about me.'

People told us that staff treated them in a respectful manner and maintained their privacy and dignity. They told us that they received care and support that was appropriate to their individual needs. Visitors told us that people were always appropriately dressed and looked well cared for when they visited.

Staff promoted people's rights to make choices in their daily life. We observed many instances when staff asked people about their choices. For example staff asked people if they wanted a drink, about activities, where they wanted to sit and what they wanted to eat.

People said that they have enough activities to keep them stimulated and occupied. However, one visitor said that as people's needs change, there could be more one to one activities as most activities seemed to be arranged for groups and for people who could express themselves.

People reported that they received a quality service and would speak with staff if they were unhappy about their care. A visitor said that staff took any concerns or issues brought to their attention seriously and addressed these to their satisfaction.

People confirmed that they were able to express their views about the quality of the service in satisfaction questionnaires. They attended meetings that were arranged quarterly to share their views with other people and management about the provision of the service.

Archived: Kent House

All Inspections

31 March 2017

During a routine inspection

25 February 2016

During a routine inspection

20, 21 & 24 August 2015

During a routine inspection

27 February 2015

During an inspection looking at part of the service

9 and 10 November 2014

During a routine inspection

17 March 2014

During an inspection looking at part of the service

21 October 2013

During a routine inspection

During a check to make sure that the improvements required had been made

10 August 2012

During a themed inspection looking at Dignity and Nutrition

9 December 2011

During a routine inspection