Archived: Kent Lodge Residential Home

Updated 15 October 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 over two days on the 9 and 14 September 2015 and was unannounced.

The inspection team consisted of two inspectors, a pharmacy inspector and an Expert by Experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert by experience had personal experience of caring for people with dementia care.

Before the inspection we reviewed the information available to us about the service, such as notifications. A notification is information about important events which the provider is required to send us by law. We also reviewed information about the home that had been provided by staff and relatives.

During the inspection we spoke with eight people who lived at the service, two relatives, two senior care staff, four care staff, one domestic, a cook and the manager. We carried out observations of the interactions between staff and the people who lived at the service throughout the day.

We reviewed the care records and risk assessments for four people. We looked at records relating to the management of people’s medicines, staff recruitment, staff training, staff rotas and systems for monitoring the quality and safety of the service.

Updated 15 October 2015

We carried out this unannounced, comprehensive inspection over two days, on the 9 and 14 September 2015 to check that the provider had made the improvements required following our previous unannounced inspections on the 30 April 2015, 9 March 2015 and the 13 and 17 February 2015.

Following our previous inspections in February, March and April 2015, we asked the provider to take action to make improvements as we found evidence of major concerns at all three inspections in relation to the quality and safety monitoring of the service. There was a continued failure by the provider to ensure that people were protected from the risks associated with improper operation of the premises. This meant that the safety and welfare of people using the service was at risk and the provider was failing to provide a safe service. There was a continued lack of training and supervision support provided for staff. The provider was not meeting the requirements of the law as they did not protect people against the risks of receiving care and treatment that was inappropriate or unsafe.

We formally notified the provider of our escalating and significant concerns following our comprehensive inspection on 13 and 17 February 2015 and ongoing emerging risk and concerns shared with us by stakeholders. We informed the provider that we were in the process of making a decision with regards to their continuing failure to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We placed a condition on their registration to stop them admitting any further people to their service. We asked the provider to inform us immediately of the urgent actions they would take with immediate effect to protect people and raise standards. We received a response to the urgent action letter on 6 March 2015. This contained a basic action plan but did not address all of the requirements of the urgent action letter. This was further evidence of our lack of confidence in the provider’s ability to understand the issues and independently ensure that the service provided safe and effective care.

We carried out a focused inspection on the 9 March 2015 following further concerns identified by the local safeguarding authority and to check if improvements had been made as described in the provider’s action plan. At this inspection we continued to have major concerns regarding the lack of action taken by the provider to safeguard people. There was a continued lack of leadership of the service as the service continued not to have a manager registered with the Care Quality Commission (CQC) as is required by law.

A further unannounced inspection on the 30 April 2015 found that some improvements had been made following the recruitment of a new manager. However, we continued to have major concerns regarding the lack of action taken by the provider to monitor the quality and safety of the service, provide training and supervision for staff and safeguard people in the safe management of their medicines as prescribed. Whilst action had been taken by the provider to rectify the lack of hot water to people’s bedrooms and install heating to bathrooms, further action was needed to maintain standards of hygiene and improvement of the laundry area.

Visits from environmental health inspectors and a fire officer highlighted a number of areas where action was required by the provider to improve the safety of the environment and protect people from the risk of harm. Although care plans had been produced and people at risk of malnutrition and pressure ulcers had these risks identified with action plans in place to guide staff in the steps they should take to mitigate and reduce risks to people’s health, welfare and safety. Action to support people at risk of inadequate nutrition and hydration was not consistent and this continued to place people at risk.

Following our inspection of Kent Lodge on the 30 April 2015 we asked the provider to send us an action plan which would describe the actions they planned to take to meet legal requirements. The provider sent us their action plan which described the action they would take. However, we found that action as described in the provider’s action plan to support staff with training, action in response to a recent fire inspection and the monitoring of people at risk of malnutrition and acquiring pressure ulcers had not been taken. This was further evidence of our lack of confidence in the provider’s ability to understand the issues and independently ensure that the service provided safe and effective care.

Kent Lodge provides accommodation and personal care support for up to 30 older people who require support including people living with dementia. On the two days of our inspection there were 14 people living at the service.

You can read the reports from our comprehensive inspection carried out 13 and 17 February 2015 and our focused inspections 9 March 2015 and 30 April 2015, by selecting the ‘all reports’ link for ‘Kent Lodge Care Home’ o our website www.cqc.org.uk

At this comprehensive inspection 9 and 14 September 2015 we found improvements with regards to the implementation and review of care plans, medicines management and supervision for staff. However, we continued to have major concerns regarding the lack of action taken by the provider to plan for continuous improvement of the service, provide appropriate training for staff and safeguard people from the risk of abuse. The provider continued not to provide staff with training relevant to their role, effective monitoring of people at risk of pressure ulcers, dehydration and failed to take action to deliver care in such a way as to meet people’s individual needs and to safeguard them from harm. People’s safety had continued to be compromised in a number of areas. This included the continued lack of checks to ensure that staff employed were of good character and safe to work with people who used the service. The provider had continued to frail to identify areas of the service that were unsafe and protect people from the risks associated with improper operation of the premises. This meant that the safety and welfare of people using the service was at risk and the provider failing to provide a safe service.

The provider has failed to register a manager with the Care Quality Commission (CQC) for four years. The current manager had been in post since March 2015. 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.

There was a lack of provider oversight and we found concerns about the ongoing financial stability of the service. We were not assured that the provider had taken all reasonable steps to meet the financial demands of providing a safe and effective service as described in their statement of purpose to the required standards.

The provider did not operate a safe and robust system when recruiting staff. Checks on the suitability of staff including Disclosure and Barring (DBS) checks had not been carried out on all staff.

Although we found some improvement at this inspection with staff provided with opportunities to receive regular supervision and attend team meetings, we found that the provider did not have a systematic approach to determine their training and development needs. Staff continued not to be provided with the training required, relevant to their roles which would provide them with the skills and knowledge to keep people safe. This failure to consider, plan and provide for the range of skills required put people at risk of their health, welfare and safety needs being met and keep them safe at all times.

At our previous inspection 30 April 2015 we found shortfalls in the support of people at risk to enable them to receive adequate nutrition and hydration. We found at this inspection people’s weight was monitored and referrals were made to the GP or dietician as necessary. However, we found that people who had been assessed as at risk of dehydration and acquiring pressure ulcers were not consistently monitored to ensure that their health, welfare and safety needs were met and this placed people at risk.

Where visits from environmental inspectors and a fire officer highlighted a number of areas where action was required by the provider to improve the safety of the environment and protect people from the risk of harm, there was a continued lack of action to mitigate these risks. Fire doors continued to be wedged open. Food and hygiene safe practices continued to be ignored by staff with these designated responsibilities to safeguard people from the risk of harm.

People continued to be at risk as there was a continued failure to ensure that people were protected from the risks associated with improper operation of the premises.

During this inspection we identified a number of breaches of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.