Karenza Care Home

Karenza Care Home is a residential care home providing personal care to up to 22 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 20 people using the service.

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

Prior to this inspection CQC had received a number of concerns regarding low staffing levels and poor care outcomes for some people.

There were not enough staff to meet people’s needs, even with agency staff covering some shifts. Some people told us they were not always able to have a wash every day with staff support. Staff confirmed this.

The service were recruiting to vacant posts at this time. Appropriate processes in place helped ensure safe recruitment.

Nearly half of the people living at Karenza required the support of two staff for all care and support. There were only two care staff planned to work with one nurse on duty at night. Staff told us people did not always have their needs met in a timely manner.

Parts of the Karenza building were in need of attention. One person’s room had areas where the plaster had fallen off the wall. The ensuite toilet was in a very poor condition. The main lounge double glazing was in need of replacement and people’s view of the grounds was obscured by moisture within the windows. This was reported to the provider.

The provider had effective safeguarding systems in place and staff knew what actions to take to help ensure people were protected from harm or abuse.

People received their prescribed medicines in a safe way. Staff used an electronic medicines management system to record all administrations. Regular medicine audits were taking place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff worked within the principles of the MCA and sought people's consent before providing personal care and assistance. Guidance in care plans guided staff to help build independence wherever possible.

Identified risks were assessed and monitored. Care plans contained guidance and direction for staff on how to meet people’s needs and reduce risks.

Care plans were electronic and contained current guidance and direction for staff to meet people’s needs. Care plans had been recently reviewed.

The food provided at Karenza was delivered pre-prepared by an external company. People’s feedback about the food was mixed. Staff were available to support people with their meals where needed.

The manager had only been in post for a few weeks prior to this inspection. They had already carried out audits and begun to review every care plan personally.

The manager and the provider had oversight of the service. An audit programme was in place to help identify any areas of the service that may require improvement. However, the poor standard of décor in parts of the service had not been addressed in a timely manner.

The manager had contacted people’s families by letter to introduce themselves and invite them in to Karenza to meet and seek their views. Staff were being met with to address any immediate issues or identify any improvements needed. Staff confirmed things had begun to change for the better.

The manager understood their responsibilities under the duty of candour. The manager and the staff worked with local health and social care professionals to meet people’s needs.

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

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10 May 2022. Breaches of legal requirements were found in relation to staff support, premises and management oversight.

We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection.

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

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.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Karenza Care Home is a care home registered to provide nursing and personal care for up to 22 people. At the time of our visit there were 22 people living at the service. Karenza Care Home is situated in the town of St Agnus. It is a single storey building with a range of aids and adaptations in place to meet the needs of people living there.

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

Where a person was at risk of choking their care, records had not been updated and it had not been reported in a subsequent review. Although staff were aware of the change in risk through the handover record there was a potential for staff not to have the information to mitigate risk. We have made a recommendation about this. Other care plans had appropriate risk assessments in place, and they were being followed by staff. Environmental risks had been identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

Staff were not receiving formal supervision to measure performance, training and wellbeing.

Systems to assess and monitor the quality and safety of the care provided were not in place. There had been no quality assurance reviews to gain the views of stakeholders of the service in order to measure the effectiveness of the service.

The service did not have adequate storage facilities. Some equipment was stored inappropriately. Large boxes of continence equipment and a chair scales were stored in a small connecting lounge used by some residents who were independently mobile. Disposable urine bottles were stored on top of a radiator cover for a resident who chose not to have them in their room. This was undignified. The premises were clean and generally well maintained. Where faults or repairs were needed these were rectified and recorded.

There was a vacancy for an activity coordinator. Staff told us they did not always have time to provide meaningful activities for people. This meant people did not experience a choice of activities to participate in or be stimulated by. We have made a recommendation about this.

The registered manager was also registered manager for two other services registered with the provider. They were not based at Karenza and relied on information about the service being shared by an interim oversight manager. A manager had recently been appointed to commence in the near future and it was the intention for them to apply for registration following a probation period. However, findings at this inspection had not been identified or acted upon by the registered manager.

Staff told us it was “always busy” and “It really is tough at times and we rely on agency staff a lot, but they are regular so know the residents well.” At this inspection we found no evidence that staffing levels were unsafe and there were enough staff on duty to meet people’s needs. The service was heavily reliant on internal and external agency staff. Apart from the occasional short notice absence, shifts were always covered. The service had some staff vacancies and recruitment to these posts was on-going. Recruitment processes were safe.

People’s health conditions were being managed and where people needed specific care, to manage on-going conditions, there were treatment plans in place that provided clear instructions for staff. Treatment plans were followed, and daily records of the care provided were completed, after each intervention, helping to ensure people received consistent care.

People’s care plans were person-centred and reflected each person’s needs and preferences. Call bells were frequent as many people either remained in bed or in their room, due to clinical needs or choice. Calls were responded to quickly, but staff told us it could be difficult to maintain. We observed people were relaxed and comfortable with staff and had no hesitation in asking for help from them. A relative told us, “They [staff] are absolutely wonderful”.

The building was clean, odour free and there were appropriate procedures to ensure any infection control risks were minimised.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Suitable visiting arrangements were in place for families to visit as per current government guidance.

People received their medicines safely and on time. Medicines were safely stored and managed. However, staff responsible for medicines did not receive checks to ensure they were competent administering and recording medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

This service was registered with us on 30/03/2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We will continue to monitor information we receive about the service, which will help inform when we next inspect.