Archived: Kelso Nursing Home

Kelso Nursing Home is a residential care home providing personal and nursing care to eight older people at the time of the inspection. The service can support up to 12 people. Accommodation is provided over two floors with a passenger lift providing access to the first floor. Meal and laundry services are provided on site. Shared facilities include a specialist bathroom, lounge area and level accessed secure garden.

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

People received safe care by a consistent staff team that knew people well and understood the actions needed to mitigate risk and reduce avoidable harm. People had their risks regularly assessed, monitored and reviewed including falls, skin integrity and malnutrition. Staff had completed safeguarding training and understood how to recognise and report abuse or poor practice. Infection, prevention and control practices were in line with the latest government guidance. Medicines were administered safely by trained staff.

Leadership was visible and promoted person centred care. Staff spoke positively about the service, felt appreciated and able to share views. Staff had a clear understanding of their roles and worked effectively as a team. Although social restrictions had been in place due to COVID-19 families remained involved in the service through video, telephone and email contact. Visiting had resumed in line with the latest government guidance. Quality assurance processes were in place, including audits for wound care and competency checks for hand washing. The registered manager utilised external professional organisations, such as the National Institute of Clinical Excellence, to keep up to date with best 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

The last rating for this service was Good (published 5 January 2018). As part of CQC’s response to the coronavirus pandemic we carried out a targeted, but not rated, inspection on 23 March 2021, to look at infection, prevention and control measures the provider had in place. We found a breach of regulation. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. 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 COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection 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 has remained 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 Kelso Nursing Home on our website at www.cqc.org.uk.

We have identified a breach in relation to the assessment of risks associated with COVID-19 infection, and to the management of some aspects of the risk of infection. Please see the action we have told the provider to take at the end of this report.

We found the following examples of good practice.

The service’s cleanliness was satisfactory. The service was free from clutter.

Personal protective equipment (PPE) was available. Staff put PPE on outside of people’s rooms and removed it in the room. All PPE was treated as clinical waste and disposed of in clinical waste bins.

The service provided ways for people to visit their relatives during the COVID-19 pandemic. Visiting arrangements had been discussed with families by emails and telephone calls. Families and carers could book visits to see their relatives.

People using the service could video call or telephone their friends and family at any time.

The service participated in the whole home testing programme, this meant people living in the home were tested for COVID-19 every 28 days. The service's staff were tested for COVID-19 every seven days, this was supplemented by twice weekly lateral flow testing,

The service had systems in place to ensure staff isolated for the required period should they test positive for COVID-19. Staff breaks whilst at work were staggered to ensure social distancing.

To enable staff in providing care safely, staff had received additional training in infection prevention and control and COVID-19 awareness. This ensured they understood the actions to take if they or the people using the service became symptomatic.

Kelso Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 12 people in one detached building. There were 10 people living there at the time of our inspection. Bedrooms are situated on the first floor with two on the ground floor and there are four rooms which could accommodate two people. The first floor is accessed via a main staircase or a lift. People have access to a communal lounge and dining area and accessible rear garden. People had a variety of care and support needs related to their physical and mental health and most were unable to speak with us to tell us their views.

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.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of the risks that people faced and understood their role in managing these to ensure people received safe care.

People were supported by enough staff to provide effective, person centred support. Staff were recruited safely with appropriate pre-employment checks and received training and support to ensure that they had the necessary skills and knowledge to meet people’s needs.

Staff had worked at the service for many years and this meant that they knew people extremely well. Interactions were kind and tactile and relatives told us that they had peace of mind that their loved ones were receiving safe, compassionate care.

People received their medicines as prescribed and staff worked with healthcare professionals to ensure that people received joined up, consistent care.

People were supported to make choices about all areas of their support and staff understood the principles of mental capacity. Where decisions were needed in people’s best interests, these were in place.

People were supported to have enough to eat and drink and there were systems in place to ensure that any concerns around weight loss were monitored. People’s preferences for meals were well known and choices were offered if people did not want the meal provided.

People preferred to spend time in their rooms, but there was access to more open areas to spend time with family or other’s if people wanted to use these. Infection control measures were in place and monitored to ensure that people were living in a safe environment.

People and those important to them were involved in planning the support they would receive and also regularly asked for their views about the support and any changes to people’s needs. Reviews identified where people’s needs had changed and reflected changes to the support provided in response to this.

People and those important to them were supported to make decisions about end of life care.

People were supported by staff who respected their individuality and protected their privacy. Staff understood how to advocate and support people to ensure that their views were heard and told us that they would ensure that people’s religious or other beliefs were supported and protected. Staff had undertaken training in equality and diversity and understood how to use this learning in practice.

People were supported to have one to one time with staff in social activities which were meaningful to them. Visitors were welcomed at the home and kept up to date about how their loved ones were.

Staff were confident in their roles and supported by the registered manager who also worked on the floor. The registered manager was approachable and available to people, staff, relatives and professionals.

Quality assurance measures were used to highlight whether any changes to policy, processes or improvements in practice were required. We were given examples where feedback had been used to drive and sustain high quality at the home.

People's needs were assessed and care plans developed to meet these needs. Care plans detailed how needs should be met and identified risks to individuals and how these were managed to prevent harm.

People we spoke with told us "I like it here very much" and "They really really take care of you".

People were protected from abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People lived in a home where there were effective infection control procedures in place, which protected people form the risk of infection.

Staff received regular supervision sessions and on going training to ensure they supported people to meet their needs.

The provider had a range of systems in place to monitor the quality of service provision. These included a complaints procedure, which was followed, and audits of the environment to inform the ongoing maintenance programme. There was also analysis of accidents and incidents to identify trends and actions to reduce the risk of further incidents.

Consent had been obtained from the person or their representative prior to support being given.

People's care plans evidence how and when they needed support and the manner in which it should be given. Care records were reviewed on a regular basis and updated if needed.

People were supported to maintain their nutritional intake and support with meals and drinking was given discreetly and at a pace that suited the individual.

Medicines were handled and administered safely in the home.

People we spoke with considered there were sufficient numbers of staff to meet people's needs and staff were kind and caring.

Staff were recruited in a safe manner and received opportunities for professional development. However, supervision procedures for staff were not sufficiently robust to ensure staff were supported in their role.

Records required for the purpose of running the service were securely stored and up to date and accurate.