Kimberley Grace Care Home

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

People we spoke with were positive about their experience of living at the service. A relative told us, "I have been really impressed with the service, all the staff are good they have a good team."

Care and treatment were planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Staff had received appropriate training. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. Medication was dispensed by staff who had received training to do so.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was well maintained and suitable for people.

People and their relatives and advocates were involved in the planning and review of their care. Care plans were reviewed on a regular basis. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner. People were supported to make plans for the end of their life.

The registered manager had systems in place to monitor and provide good care and these were reviewed on a regular basis.

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 requires improvement (published 5 February 2020). At this inspection the service has improved to good.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kimberley Grace Care Home on our website at www.cqc.org.uk.

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.

We found the following examples of good practice.

¿ The registered manager was following the government’s guidance on whole home testing for people and staff.

¿ Staff had received training on working during the pandemic in relation to COVID-19 and had received training in the correct use of PPE.

¿ People were supported to isolate when required and the environment had been set up to encourage social distancing when people were able to meet in communual areas.

¿ Staff completed regular health screening on people to help identify any symptoms early.

¿ New admissions were assessed prior to admission and tested for COVID-19. On admission they were supported to isolate.

¿ At the time of inspection visits to the service had been halted due to the current lockdown. If people were on end of life care visits were being facilitated. The registered manager had processes in place ready for when visits could recommence, including a dedicated area with separate external access.

¿ People’s well-being was supported by video and telephone calls to relatives and staff continued to engage in activities with people of their choice.

Kimberley Grace Care Home is a residential care home providing personal and nursing care for up to 17 older people. Some people who resided at the service were living with dementia. At the time of our inspection there were 16 people living at the service and this included one person who was in hospital. Kimberley Grace Care Home accommodates people in one adapted building across three floors.

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

Not all risks to people’s safety and wellbeing were assessed or recorded and improvements were still required relating to safe medication practices and procedures. The service’s fire arrangements were not safe. No information was available to evidence if improvements required as cited within the service’s fire risk assessment had been completed. The service’s fire alarms and emergency lighting were not regularly tested and not all staff had participated in fire drills, particularly night staff. Satisfactory arrangements were not in place to ensure there were enough staff to meet people’s needs and the tool used to determine the number of staff required was not ‘fit for purpose’. Findings from this inspection showed lessons were not learned and improvements were not made when things went wrong. People told us they were safe. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff knew what to do to safeguard people. Safe recruitment practices were in place to make sure the right staff were recruited although not all gaps in employment had been explored. People were protected by the prevention and control of infection.

Staff training records showed not all staff employed at the service had received mandatory training in key topics. Not all staff had received an ‘orientation’ induction. Staff had not received regular supervision or an annual appraisal of their overall performance. People were not always supported to access healthcare services and receive ongoing healthcare support. The dining experience for people was positive and they were complimentary about the meals provided. The service worked with other organisations. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, best interest assessments were not completed where bedrails and sensor alarms were in place.

People’s comments about the quality of care and support they received was positive. People told us they were treated with care and kindness. People were treated with respect and dignity.

Not all people using the service had a care plan in place detailing their care and support needs. Improvements were still required to ensure information clearly recorded people’s care and support needs and the delivery of care to be provided. Though efforts were made to engage people in ‘in- house’ activities, people were not supported to participate in social activities within the local community. The service was not fully compliant with the Accessible Information Standard to ensure it meets people’s communication needs. People and those acting on their behalf were confident to raise issues and concerns.

Suitable arrangements were still not in place to ensure the leadership, management and governance arrangements at the service were effective and outcomes for people assured high quality and person-centred care. Our findings demonstrated the provider did not have good oversight of the service and little improvement had been made since our last inspection to the service in October 2018.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The rating at our last inspection was requires improvement (published December 2018). There were four breaches of regulation. These related to breaches of Regulation 9 [Person-centred care], Regulation 12 [Safe care and treatment], Regulation 14 [Meeting nutritional and hydration needs] and Regulation 17 [Good governance].

At this inspection we found minimal improvements had been made to address previous identified shortfalls. Although the provider was no longer in breach of one out of four regulations, the service remains in breach of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and Local Authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This was the service’s first inspection since being newly registered on 8 June 2017.

The inspection was completed on the 10 and 11 October 2018 and was unannounced. At the time of the inspection, there were 16 people living at Kimberley Grace Care Home.

The service had a registered manager in post and they were formally registered with us on 30 May 2018. 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.

Improvements were required to the service’s governance arrangements to assess and monitor the quality of the service. The current arrangements had not identified the issues we found during our inspection. The registered provider lacked oversight as to what was happening within the service to make the required improvements. Suitable arrangements were not in place to review and investigate events and incidents and to learn from these. Although issues were highlighted as part of the service’s quality assurance arrangements, systems in place did not ensure these were addressed, followed-up and lessons learned.

Although people told us they were safe, suitable arrangements were not always in place to act when abuse had been alleged or suspected. Medication practices and procedures required strengthening to ensure these were in line with good practice. Not all people’s care and support needs and risks to their safety and wellbeing were recorded and detailed within a care plan. The nutritional and hydrational needs of people using the service required improvement as it was not possible to determine if their diet was satisfactory or not.

The deployment of staff required improvement as communal lounge areas were often left without staff support. Suitable arrangements were required to ensure all staff training was up-to-date. Where staff were promoted to a more senior role, they had not received an appropriate induction and mentor arrangements were not effective. Although staff received regular supervision, where performance issues were raised, these had not always been followed up and monitored.

The management team had not ensured the service was being run in a manner that promoted a caring culture and care provided was task and routine led rather than person-centred. People were not offered regular opportunities to participate in regular leisure and social activities.

People’s healthcare needs were supported and people had access to a range of healthcare services and professionals as required. The registered provider’s arrangements for the prevention and control of infection at the service was satisfactory. People’s capacity to make day-to-day decisions had been considered and assessed. Nonetheless, care was needed to ensure information recorded was accurate and not contradictory.

Complaint management arrangements were appropriate and people told us they were confident to raise issues.