Kavanagh Place

Kavanagh Place is a residential care home providing nursing and personal care to 38 people at the time of the inspection. The service is registered to support up to 42 people. 40 people are supported in one adapted building located across four units over two floors, and a further two people are supported in separate accommodation situated off the main site across the road.

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

People had personalised risk assessments which gave staff the information needed to safely manage the risks associated with people’s care. There were some inconsistencies with the recording of some of the care being delivered, however we were assured people had their needs met safely. The provider told us they would address recording concerns immediately.

People received their medicines safely and as prescribed. Medicines were stored safely and audited regularly to ensure good practice was maintained. We found two recording errors during the inspection which the provider thoroughly investigated and appropriate action was taken to minimise the risk of repeated errors.

Accidents and incidents were recorded, and actions were in place to ensure people were safe. Referrals were made to healthcare professionals when needed to ensure good outcomes for people.

The environment was safe and well-maintained. The home was clean and effective infection prevention and control measures were in place. Some areas of the home were not as well maintained as others, however there was a programme of refurbishment underway during the inspection which included the areas of concern.

There were enough staff at the home to meet people’s needs. Staff were visible around the home and were readily available to support people when needed. Staffing levels were monitored, reviewed and amended when needed by the manager.

People were safeguarded from the risk of abuse. Staff had received safeguarding training and understood their role in recognising and reporting safeguarding concerns. The provider had appropriate systems in place to manage concerns of a safeguarding nature.

There was a kind and caring culture. Staff knew the people they supported well and we observed many positive interactions throughout the inspection. Relatives spoke of staff going above and beyond their duties to support their loved ones in a caring and compassionate way. One relative said, “I can’t explain how happy I am with way [person] is treated, it’s like [person] is one of the family. The care is second to none.”

There had been multiple changes within the management team since the last inspection. The provider ensured there was appropriate management cover during this period. Relatives told us they felt communication with the home could be improved as they were not always aware of changes at the home and did not feel they always got a response to queries.

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 good (published 29 August 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing levels, leadership of the service and environmental concerns. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the environment and aspects of the governance of the service so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe and Well-led

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kavanagh Place 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.

Kavanagh Health Care Limited is owned by Exemplar Health Care and is situated in the Kirkdale area of Liverpool. Kavanagh Health Care is ‘care home’ and provides support for up to 40 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Kavanagh Health Care Limited is registered to provide accommodation with nursing and/or personal care to people with mental health support needs including early onset dementia, neurological disorders and complex physical disabilities.

At the time of the inspection there was a registered manager in post. 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. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in June 2017, we identified breaches of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Kavanagh Health Care Limited was awarded an overall rating of ‘Requires Improvement’. Following the inspection, we asked the registered provider to complete an action plan to tell us what improvements they would make and by when.

During this inspection the registered provider was found to be complying with all Health and Social Care Act regulations and was awarded an overall rating of ‘Good’.

At the last inspection we identified that some medication management procedures were not safely in place. Topical preparations (medicated creams) and prescribed thickeners (prescribed thickening agents for people with swallowing difficulties) were not recorded appropriately. We also found several omissions on medications records which indicated some diet supplements had not been given as prescribed. During this inspection, we found that the medication management processes had improved. Staff were complying with all medication policies and procedures and people safely received medicines that had been prescribed. The registered provider was no longer in breach of this regulation.

Care plans and risk assessments were safely in place. People were suitably assessed, risks were identified and support measures were implemented to manage and mitigate risk. Risk assessments were regularly reviewed and the appropriate clinical tools were completed to manage the level of risk which had been identified.

All four units were sufficiently staffed and people received the level of care and support they required. We received positive feedback from relatives and staff about staffing levels within the home. We were informed that staffing levels were appropriately managed and people received safe care from people who had the necessary skills and competencies. Staff were visible throughout the inspection and were responsive to people’s needs.

Staff were safely recruited which meant that people received safe care and support from staff who were assessed as being ‘fit and proper’ to work with vulnerable adults. Staff recruitment files we checked contained the relevant records, documentation and Disclosure and Barring Service (DBS) checks.

Staff were knowledgeable around the area of ‘safeguarding’ and ‘whistleblowing’ procedures. Staff explained who they would report their concerns to and how they would report their concerns. Staff received the necessary safeguarding training, there was an up to date safeguarding policy in place and staff were aware of how to access such policies if needed.

Accidents and incidents were routinely reported and recorded. Staff were aware of the ‘accident and incident’ reporting procedures and there was an appropriate policy in place. Accident and incidents were routinely analysed and trends were established. This meant that the appropriate measures were put in place to mitigate any risks which were identified.

We found the home to be clean, hygienic and odour free. Communal areas, toilets, bathrooms and bedrooms were well maintained. Staff had access to personnel protective equipment (PPE) such as gloves, aprons and hand gels. There was an infection control policy in place and staff understood the importance of complying with infection prevention control procedures.

Health and safety audit tools and checks were in place. Health and safety processes help to monitor and assess the quality and standard of the home. There was a variety of different audits/checks conducted which meant that people were living in a safe environment.

People’s nutrition and hydration support needs were safely and effectively managed. People were regularly assessed and measures were in place to monitor and mitigate risk. We found that appropriate referrals were made to the relevant healthcare professionals and the guidance which was provided was incorporated within care plans.

People received holistic level of support from healthcare professionals such as physiotherapists, speech and language therapists, district nurses and occupational therapists. People received an effective level of safe, care and treatment that was tailored around their individual support needs.

We observed positive interactions between staff and people living in the home. Staff were kind, caring and friendly. Relatives also told us that the staff provided compassionate and sincere care. It was evident throughout the course of the inspection that staff were familiar with the people they were caring for.

Confidential information was securely stored in line with General Data Protection Regulations (GDPR). People’s personal information was appropriately protected and sensitive information was not unnecessarily shared with others.

A person-centred approach to care was evident. Records were tailored around the support needs of the person and it was evident throughout the course of the inspection that staff were familiar with the different likes, dislikes, preferences and wishes of the people they were supporting.

There was a variety of different activities available for people to engage in. Activities were stimulating, engaging and promoted social interaction and independence. At the time of the inspection there were two activities co-ordinators in post. We were told that the range of different activities had recently improved.

‘End of life’ care was provided although staff did not receive routine ‘end of life’ care training. The registered manager explained that this was something that would be explored and encouraged amongst the staff team.

Complaints were responded to in line with the registered providers policy. A recent survey suggested that further developments needed to be made around the complaints procedure, ensuring that all people were familiar with the process.

The registered provider had a range of different policies and procedures in place. Staff were familiar with a range of policies we discussed with them during the inspection. They explained where they could be located if they needed further advice and guidance. Some of the policies we reviewed during the inspection did not contain the relevant information. Following the inspection, we were provided with the most relevant and up to date policies.

Audit systems were in place and checks were routinely completed. Audits and checks enabled the registered provider to monitor, assess and improve the quality and safety of care people received. We did feedback to the registered manager that some of the quality assurance paperwork could be further developed to identify when follow up improvements and actions had been completed.

Systems and processes were in place to gather feedback regarding the provision of care provided. People, staff and relatives were encouraged to share their views, opinions and thoughts around the standard and quality of care people received. Feedback and actions were discussed at the relevant staff and managers meetings regarding people and relative feedback; although staff feedback required further analysis.

The registered manager had notified the Care Quality Commission (CQC) of all events and incidents that occurred in the home in accordance with the statutory requirements. Ratings from the last inspection were displayed within the home and on the registered provider’s website as required.

This was an unannounced inspection which took place on 14 and 16 June 2017. The service was last inspected in May 2016 and at that time was given a quality rating of ‘good’.

There were 38 people accommodated at the time of our inspection.

There was a registered manager in post. 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.

We reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication. Some medicines given such as external medicines [creams] and prescribed thickeners (used for thickening fluids for people with swallowing difficulties) were not being recorded appropriately. We found some omissions on records which indicated some diet supplements had not been given as prescribed.

The registered manager was able to evidence a series of quality assurance processes and audits carried out internally and externally by staff and from the provider’s visiting senior managers. We found these were developed to help ensure effective monitoring and development of the service as well as helping to ensure standards were continually maintained. We found however, that audits for medicines management had not identified the concerns we found on inspection.

The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed on a regular basis where obvious hazards were identified.

Planned development / maintenance was assessed and planned well so that people were living in a comfortable environment. We found some examples where access to facilities could be improved for people. The development of environmental cues for people living with dementia would help orientate people with their surroundings to promote their wellbeing.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained. Most people were satisfied with living in the home and felt the care of offered met their care needs. People we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of people’s input.

We saw written care plans were formulated and care reviews were ongoing. Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

The registered manager had made referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were completed and were being monitored by the registered manager.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw checks had been made so that staff employed were ‘fit’ to work with vulnerable people.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each person’s care needs and how they communicated these needs. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

We saw people’s dietary needs were managed with reference to individual preferences and choice.

People we spoke with said they were happy living at the home. They spoke about the nursing and care staff positively. When we observed staff interacting with people living in the home they showed a caring nature with appropriate interventions to support people.

We discussed the use of advocacy for people. There was information available in the home regarding local advocacy services if people required these.

Activities were organised in the home and these were appreciated by the people living at the home. We saw an activities programme. The staff member who organised these was motivated to provide meaningful and stimulating activities.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw that a record was made of any complaints and these had been responded to.

You can see what action we told the provider to take at the back of the full version of the report.

Situated in North Liverpool and located close to public transport links, leisure and shopping facilities, Kavanagh Place is registered to provide accommodation for up to 40 people with personal and nursing care needs. At the time of the inspection 38 people were living at the home. The location is a two storey property with a passenger lift between the floors. It has four separate units that provide care for people with specialist nursing needs. Each bedroom has its own en-suite facilities.

A registered manager was in post. 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 registered manager was not available on the day of the inspection.

Each of the three people that we spoke with told us that they felt safe living at Kavanagh Place. Staff had received training in safeguarding and were able to explain what they would do if they suspected that someone was being mistreated.

People living at the home had detailed care plans which included an assessment of risk. These were subject to regular review and contained sufficient detail to inform staff of risk factors and appropriate responses.

Accidents and incidents were accurately recorded and were subject to assessment to identify patterns and triggers. Records were detailed and included reference to actions taken following accidents and incidents. Reference was also made to behaviours, observations and other issues that may have led to an accident or incident.

Staffing numbers were adequate to meet the needs of people living at the home. The provider based staffing allocation on the completion of a dependency tool. We were provided with evidence that this information was reviewed following incidents where new behaviours were observed which might increase or change people’s dependency level.

People’s medication was stored and administered in accordance with good practice. We spot-checked medicines administration records and stock levels. We saw that records were complete and that stock levels were accurate.

Staff were suitably trained and skilled to meet the needs of people living at the home. The staff we spoke with confirmed that they felt equipped for their role. The training matrix and staff certificates showed that the majority of training was in date.

The records that we saw showed that the home was operating in accordance with the principles of the MCA. Capacity assessments were not generic and were focused on the needs of each individual. Applications to deprive people of their liberty had been submitted appropriately.

Food was produced using fresh ingredients to a high standard and offered good choice. People could choose to eat in dining rooms or other areas of the home. Drinks were provided at regular intervals and on request.

People were supported to maintain their health through regular contact with healthcare professionals.

Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used language, pace and tone that was appropriate to the individual.

Each of the people living at the home that we spoke with said that they were encouraged and supported to be independent. Throughout the inspection we saw people moving around the building independently and engaging in activities of their own choosing.

Staff spoke with people before providing care to explain what they were doing and asked their permission. Where people didn’t respond staff repeated or re-worded the question to ensure that the person understood.

Staff were attentive to people’s appearance and supported them to wipe their hands, face and clothing when they had finished their meal. When we spoke with staff they demonstrated that they understood people’s right to privacy and the need to maintain dignity in the provision of care.

People’s preferences and personalities were reflected in the décor and personal items present in their rooms. Important items and photographs were prominently displayed. However we saw that the personalisation of rooms was limited in some cases.

People and their relatives were involved in care planning and review on a regular basis.

The home employed activities coordinators but we also saw staff actively involved in organising activities and motivating people to take part. The home displayed an activities board which detailed a varied programme of activities. However, we noted that activities were generic and personal hobbies and interests were not regularly considered.

Information regarding compliments and complaints was clearly displayed and the provider showed us evidence of addressing complaints in a systematic manner. All of the people that we spoke with said that they knew what to do if they wanted to make a complaint.

People living at the home spoke very positively about the quality of the care provided and the management of the home.

Staff were motivated to provide good quality care and supported to question practice. Staff told us that they felt confident in speaking to the registered manager or reporting outside of the home if necessary.

The provider had systems in place to monitor safety and quality and to drive improvements. We saw evidence of a quality assurance programme which detailed requirements and themes for each month. We also saw evidence of regular audits and detailed reports relating to; health and safety, fire safety, water temperatures and maintenance of buildings and equipment. The records that we saw indicated that all audits had been completed in accordance with the provider’s schedule.

We have followed up to make sure that the necessary changes have been made and found the provider is now meeting the standard included within this report. This report should be read in conjunction with the full inspection report.

We visited Kavanagh Place as part of this review. We reviewed records and spoke to staff. This confirmed that they were now meeting the standards.

During our visit we spoke with 10 people who used the service, visitors and staff. We looked at the care records of people who used the service to see how their needs should be met. We also looked at staff rotas, audit information and information on complaints.

During our visit we observed that rapport and interaction between the people who used the service and staff was variable, depending on which of the four separate wings we were on. People who used the service told us that although they were given choices they were very limited.

Some people who used the service had limited verbal communication but could communicate in a number of other ways. They were supported by staff who knew the appropriate way to communicate with them when decisions needed to be made about their care and welfare.

All people who used the service had an individual care record. We noted that although people who used the service were asked about their choices and preferences, consent was not consistently recorded in their care records.

There were enough qualified and skilled staff on duty to meet the needs of the people who used the service. However we observed that staff were involved in the completion of tasks rather than interaction with the people who used the service.

We spoke with three service users two family members four member of staff and two stakeholders. Everyone was positive about the service and made comments such as ''my relative is settled and has progressed since moving here''. ''There is nothing that they could do better'' and ''My relative has had good access to the community and a choice in the bedroom decoration to suit their age and taste and has a good programme of physiotherapy''.

Staff members felt supported and enabled to continue their own training and development.

In addition to accessing the local community facilities there was a varied programme of events taking place within the service including massage and relaxation therapy, baking, movie afternoons and games of football. Kavanagh Place also has its own mini bus to facilitate trips out and holidays.

During our visit people were seen to be interacting well with each other.