Archived: Kevlin House

We spoke with eight people who used the service, two relatives and eight staff members. The staff included the registered and deputy managers. We reviewed four people's care records. We also reviewed a selection of other records that included maintenance records, environmental risk assessments and audit results.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty.

At the time of this inspection no person was subject to a DoLS authorisation. However, we found that some people were restricted of their liberties without the provider following the principles of the MCA (2005) and DoLS. We have asked the provider to tell us what they are going to do meet the requirements of the law in relation to the MCA, its main Codes of Practice and DoLS

Although the home was visibly clean there were not always effective systems in place to reduce the risk and spread of infection. This included no availability of single use towels for staff to dry their hands and a lack of Personal Protective Equipment (PPE) for staff. The laundry area was not designed and assessed to minimise the risk of infection. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring a clean and hygienic environment.

The provider had not taken steps to provide care in an environment that was always suitably designed and adequately maintained. There were significant risks to people in relation to the uneven ground in the rear garden and unguarded radiators. The provider had failed to have legionella bacteria checks for a number of years. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safety and suitability of premises.

There were enough suitably qualified and experienced staff to meet the needs of the people who used the service. However, it was dependent on whether there were enough staff on duty as to whether people could be assisted outside.

There were some procedures in place to manage and mitigate foreseeable emergencies. These included procedures in relation to fire, evacuation and emergency lighting.

Is the service effective?

People's care records demonstrated that their needs had been assessed and there were detailed care plans and risk assessments in place. Care and support was evidence based and included nationally recognised screening tools to help determine the level of people's needs.

Three out of four of the plans of care and risk assessments we reviewed were regularly updated in order to reflect any changes in people's needs. However, one person's risk assessments had not been reviewed on a regular basis. We have highlighted this to the provider.

We saw evidence that the care and support people received, generally reflected their needs. Daily records were kept for each person. These contained information about how people's needs had been met. The records were detailed and included all aspects of daily living.

Is the service caring?

We spoke with eight people who used the service. Generally, people's comments were positive. One person said, 'It's lovely here. The staff are lovely.' Another person said, 'I am happy here. The staff are good. The food is good. I choose to stay in my room.' A third person said, 'It's alright here but the staff don't do many activities with people.'

We spoke with the relatives of two people. One relative said, 'I have no concerns about the care my (relative) receives. All of the staff are lovely and attend to my (relative) properly. We feel content that my (relative) is in here and being well looked after.' Another relative said, 'I am very happy with the care that my (relative) gets in here. The staff are lovely and kind. My (relative) gets well looked after.'

We observed the interaction between the staff and the people who used the service. Generally, staff were kind and caring towards people. We saw that staff took their time to ensure that people's needs were being met. There were three occasions however when staff did not display an understanding of the needs of people living with dementia. We have highlighted this to the provider.

Is the service responsive?

People's needs had been assessed before they moved into the home. This was to help ensure that the service could meet their needs. People's care plans and risk assessments responded to their individual needs. People were encouraged to undertake activities that were meaningful to them. However, the service could not respond to some people's activity preferences some of the time. We have highlighted this to the provider.

The service had a complaints procedure and we saw evidence that complaints were audited and acted upon to help improve the quality of the service.

Is the service well-led?

Quality assurance processes were in place. These included a monthly audit of the service undertaken by the deputy manager. Not all of the processes were effective. An example of this was continuous offensive odours within the home.

There was a process in place to collect relatives' views about the care and support that people received. However, there was not a process in place to collect the views from people who used the service or the staff. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to assessing and monitoring the quality of the service.

The care staff we spoke with told us that they were happy working in Kevlin House. There were positive comments made about the management team and they said that generally, they felt well supported. The staff told us that they did not feel encouraged to give their views about the quality of the service during staff meetings. We have highlighted this to the provider.

Following our previous inspection in September 2013 we required that the provider send us an improvement action plan. We received this on 26 September 2013. This told us what steps would be taken to rectify the issues previously identified.

The acting manager advised us that all care plans were due to be reviewed at the beginning of each month. Mostly, this had been adhered to, but there will still a few gaps where this hadn't been done to ensure plans reflected how people's current needs were to be met. People's weights were now being recorded monthly and nutritional recording had improved. This meant that changes in people's wellbeing could be identified and acted upon. We found that improvements had been made.

We were satisfied that any reportable incidents had been notified to us and other external bodies as appropriate.

We reviewed three people's care records. Whilst detailed they required reviewing. Records were comprehensive, but kept in different places which made it hard to establish an overall view of someone's health. Where nutritional needs had been identified, some actions had been taken, but no plan had been made and progress was not being monitored.

Staff were up to date with mandatory training. Safeguarding training was due and this had been arranged. Staff we spoke with told us about additional training that had been provided. Supervisions were being carried out, however some appraisals were overdue.

We found that some notifications that were required to be made to the Care Quality Commission had not been completed. This has subsequently been rectified.

Medicines were kept securely and administered appropriately. We were able to confirm that records held tallied with the stock held. Staff described the process they undertook when administering people's medications and what they would do if someone declined their medication.

We spoke with a relative of one person living in Kevlin House who told us that they were very happy with the care provided in the home. This person also told us that the provider and manager were very approachable and kept them informed of any issues or changes with regard to their relative. They also added that the home was always lovely and warm and the food was excellent in respect of choices, quantity and quality.

During our inspection we saw that people's body language, expressions and mannerisms were relaxed and comfortable in the presence of all the staff we saw on duty.

The visitor we spoke with told us how the home had arranged for their relative to have personalised equipment in their room such as a new bed, ripple mattress and a new chair had been applied for.