Archived: Knebworth Care Home

We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Knebworth Care Home on our website at www.cqc.org.uk

This inspection was carried out on 7 February 2017 and was unannounced. At this inspection we found that they were meeting all the standards we reviewed.

Knebworth Care Home provides accommodation for up to 71 older people, including people living with dementia and with nursing needs. At the time of the inspection there were 38 people living there. This was because at a previous inspection we had restricted admissions to the service. However, following this inspection we found that the provider had made the necessary improvements and the conditions were removed.

The service had a manager who was not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. The manager was awaiting some updates to documentation before they were able to submit their registered manager’s application.

People received their medicines safely and there were systems in place to robustly monitor this.

Risks to people’s welfare were assessed and managed. People were supported by staff who knew how to recognise and report abuse.

There were sufficient staff to meet people’s needs and these were recruited safely.

The manager had not yet registered with the Care Quality Commission, however, this application was pending. There was positive feedback about the manager and the way the service was running from people and staff. The quality assurance systems in place were being used effectively.

Knebworth Care Home is registered to provide accommodation for up to 71 people. The home provides support with personal care and nursing care for older people, some of whom live with dementia. At the time of the inspection there were 44 people living there at the time of our inspection.

The service had a manager who was not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People’s medicines were not always managed safely. Although improvements had been made, there were still areas that required further development. We also found that although care plans had been developed to include more up to date information, these still required work to ensure they included all specific information about people’s needs. Systems had been implemented to monitor the quality of the service, promote people’s safety and address any shortfalls. However, these were still in the early stages and these required more time to embed and demonstrate their effectiveness.

People told us they felt safe and staff knew how to recognise and respond to any concerns of abuse. Individual risk assessments were completed and staff were familiar with these. Accidents, incidents and unexplained bruises were reviewed an investigated by the manager.

People’s consent was sought and the service worked in accordance with MCA and DoLS legislation. However, they had not ensured that they had a record of documentation that authorised a relative to act on a person’s behalf.

People felt staffing levels had improved. Staff training and supervision was a work in progress however, staff felt this was better and felt supported. Recruitment practice needed to be improved to ensure that all staff had any employment gaps explored.

People enjoyed their food and told us there was plenty of choice. People received the appropriate support with eating and drinking. There was access to health care professionals as needed. People told us they enjoyed the activities available and this was an area that was still being developed by the service. Complaints were responded to, however, the management team needed to ensure all actions were documented.

People felt that staff listened to them but further work was planned to ensure that their involvement in planning and reviewing their care was consistent. Confidentiality was promoted.

Knebworth Care Home provides accommodation and personal care for up to 71 people. At the time of this inspection 56 people were living at the service.

The service had a manager in post who had recently applied to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. However, the manager informed us that they were leaving the service and had withdrawn their application. We were informed by the provider that the manager left the service the week following the inspection.

People did not always receive care that met their needs and kept them safe. We found people’s medicines were not managed safely and that staffing levels were not consistent or sufficient to meet people’s needs. People’s individual risks were not consistently assessed and managed and as a result incidents affecting people’s welfare had occurred. People were not protected against the risk of abuse and some issues had not been reported appropriately. Recruitment processes were in place but needed reviewing to ensure they were effective.

People did not have their capacity to make decisions assessed and Deprivation of Liberty Safeguards were not applied for where restraint was being used. People were supported by staff who were trained and supported, however this was not consistent and required improvement.

People had a variety of foods but we found that appropriate support with eating and drinking, particularly in relation to dietary requirements, was not always received. Weight and nutritional monitoring was not effective. People had access to health and social care professionals, however, this was not recorded accurately and there were occasions when a person had required a service that had not been delivered.

People did not have end of life care plans in place even when they were nearing the end of their lives and this did not promote their dignity. People and their relatives were beginning to be more involved in the planning of their care. However, this was an area that required improvement.

Confidentiality was promoted in regards to records being retained securely but staff spoke loudly about people’s needs where conversations may be overheard. People were positive about the kindness shown by staff.

People’s care needs were not consistently met and care plans did not include clear guidance for staff in regards to all aspects of their needs and communication was not effective.

Activities were available and work was ongoing to improve these. However, people who were nursed in bed did not receive activities. Complaints, in the most part, were responded to appropriately.

Quality assurance systems and audits completed had not identified the issues found on our inspection and as result people’s safety and welfare were put at risk. Information presented to the manager by the staff team to enable them to monitor the service was inconsistent and inaccurate.

People, relatives and staff were positive about the manager and the improvements that had been made. However, the manager left the service the week following our inspection. Meetings were held and lessons learned shared however there was poor leadership on units to ensure safe practice was continued. The provider had set up managerial support in the form of a registered manager within the organisation and a clinical support lead and were recruiting for key lead roles in the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

.

At our inspection on 9 September 2014 we found that although there had been improvements on one unit we viewed, on the second unit we looked at, there were significant shortfalls. The issues we identified were in regards to the accurate recording of medicines, quantities of medicines in stock and ensuring people received the appropriate amount of medicines.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service and the staff that supported them. We also spent time looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care was planned and delivered in a way that was intended to ensure people’s safety and welfare.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Where applications had needed to be submitted, proper policies and procedures were followed. Relevant staff had been trained to understand when an application should be made, and how to submit one.

However, we found that there were shortfalls in relation to the management of medicines and the service is required to make improvements.

Is the service effective?

People told us that they were happy with the care that they received and that their needs had been met. Care plans were written in a way which reflected people’s choice and preferences. Staff asked for people’s consent before providing care and support.

We saw that most of the risk assessments and support plans had been reviewed monthly and where needed, updated to reflect the person’s current needs. We looked at the care notes for people whose plans we had viewed and saw that care was delivered in accordance with the plans.

Is the service caring?

People told us that care and support was delivered in a way in which they preferred. We asked people were the staff caring. One person described staff to us as, “Perfect.” They went on to say, “Couldn’t fault them on anything.” They also told us, “They are willing to help, very willing.” Another person we spoke with said, “The staff are wonderful.”

We observed staff interaction with people who used the service and noted that they appeared to know people well. Staff were attentive and kind. There was conversation between people who used the service and staff that made for a friendly and comfortable atmosphere. Staff we spoke with had a good understanding of the people that they were supporting.

Is the service responsive?

We found that the service responded to issues identified through their own monitoring systems. This enabled them to monitor trends in areas such as incidents, falls, infections and complaints. Any trends identified were responded to and actions for minimising any reoccurrence were put in place.

We saw that where concerns had been highlighted during the monitoring process that the service had responded to these issues in an appropriate timescale to resolve them.

Is the service well led?

We noted that the manager for the service was sick at the time of our inspection and an interim manager from another service with in the provider organisation was providing management cover. They were being supported by the regional manager.

People told us that they knew how to make a complaint and we noted that the management had responded appropriately to complaints made by people who used the service.

The service carried out regular audits on care plans, medication and environment. We saw that where an audit identified an issue, an action plan had been developed and there was a record of actions being completed.

Surveys were sent out annually to people who used the service, their relatives and staff. The acting manager and regional manager had taken steps to address any issues identified. This included introducing regular meetings.

People's care was planned according to a detailed assessment of their needs. People and their relatives were involved in regular reviews of their care plans. Staff delivered appropriate care to people because they knew the people they were looking after well. Care and treatment was delivered safely because the provider carried out regular risk assessments.

People were protected from abuse because the provider ensured that staff were knowledgeable about local safeguarding procedures.

People were cared for by a staff team that was supported to attain the level of skills necessary for their role.

The provider used robust quality auditing methods. People's comments were taken into account to improve the service.