Archived: Keswick

Updated 6 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 27 June 2017 and was unannounced. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is someone who has experience supporting people and is used to gain their views of their support.

Before the inspection, we checked the information that we held about the home and provider. This included statutory notifications sent to us about incidents and events that had occurred at the home. A notification is information about important events which the provider is required to tell us about by law. We also reviewed any complaints, whistleblowing and safeguarding information from relatives and staff. A provider information return (PIR) was received which was used to aid the inspection planning process. We used all of this information to plan for the inspection.

During the inspection we spoke with 20 people, four relatives, seven care staff and a visiting care professional. We also spoke with an activity coordinator, the deputy manager, registered manager and district manager. After the inspection we requested more information from the provider, which was sent to us.

We observed care and support being provided in the lounge, dining areas, and with people’s consent, we visited people in their bedrooms. Some people had complex care needs which meant some had difficulty describing their experiences of living at the home. We 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. We also observed people receiving their medicines and spent time observing the lunchtime experience people had.

We reviewed a range of records about people’s care and how the home was managed. These included 11 people’s care records and medicine administration record (MAR) sheets and other records relating to the management of the home. These included staff training, three employment records, quality assurance audits, accident and incident reports and any action plans.

Updated 6 September 2017

Keswick is a care home that provides support to up to 52 people. The people at the home have a range of needs and are supported with a full range of tasks, including maintaining their health and well-being, personal care, support with nutrition and social activities. The service is spilt into seven units, which have their own lounge. On the day of the inspection 51 people were being supported. An additional six people come to Keswick to use it as a day service facility.

On the day of inspection we met the registered manager. 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.

The inspection was unannounced and took place on 27 June 2017.

When we last inspected the service on 17 March 2016 we highlighted shortfalls in the delivery of support to people, particularly with regards to their safety and individualised support. On 17 March 2016 we highlighted inconsistencies with the implementation of the Mental Capacity Act (MCA). We also observed that staff did not always treat people with dignity and respect. Following that inspection the registered manager sent us an action plan explaining how they were going to address the two breaches of regulation we found. During this inspection we found there had been improvements in all of these areas and all these shortfalls had been rectified.

During this inspection people felt safe at Keswick. Risks of harm to people were identified at the initial assessment of care and staff understood what actions they needed to take to minimise risks. Staff understood people's needs and abilities. There was sufficient staff to meet people’s needs.

People were supported by staff who understood the signs of abuse and their responsibilities to keep people safe. Safeguarding concerns had been appropriately reported. Recruitment practices were followed that helped ensure only suitable staff were employed at the service.

People were supported with the medicines safely. Staff were confident and had the knowledge to administer medicines safely. They knew how to support people to take their medicines safely and to keep accurate records.

People received person centred care and people were supported with activities which were meaningful to them and were in line with their interests and preferences.

Although some improvements had been made people did not always have up to date records that reflected their needs. The impact on people was low because we observed people receiving the support they needed and wanted during the inspection. We also saw that an inaccurate record was recorded on the day of inspection. This record did not reflect people’s views. We have recommended that the registered manager ensures that records reflect the support and views of people.

Staff felt they received the training and support they needed to meet people's needs effectively. Staff felt supported by the management team and there was good feedback about staff induction.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of MCA and DoLS. When people lacked capacity the best interest process was followed.

People were supported to eat meals of their choice and staff understood the importance of people having sufficient nutrition and hydration. Staff referred people to healthcare professionals for advice and support when their health needs changed.

People praised staff for their caring nature. Staff were kind and respected people’s privacy, dignity and independence. Care staff were thoughtful and recognised and respected people's wishes and preferences.

People knew how to complain and were confident any complaints would be listened to and action taken to resolve them. Staff understood the values of the organisation and this was reflected in the support we observed.

The registered manager audited the care and support delivered and sought feedback from people and relatives regarding the support received.

The registered manager understood their responsibilities in terms of notifying CQC of significant events at the service. Staff support people in line with the organisational values as support was centred around increasing people’s independence.