Archived: Kinross

Kinross is a residential care home providing personal care for up to 29 people aged 65 and over, including people living with dementia. At the time of the inspection they were supporting 13 people. Accommodation is arranged over two floors connected by stairs and a passenger lift. There is a range of communal areas on the ground floor including a dining room and two lounges.

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

People and their relatives said the service provided safe care and we found improvements had been made since the previous inspection. The provider had introduced tools and systems to promote people’s safety and these were being embedded into the service. The provider acted promptly to address any concerns we found during the inspection. Staff knew about the risks to people and acted to provide safe care. Environmental risks were assessed, monitored and acted on. Safeguarding processes were known and followed to protect people from abuse.

The provider assessed staffing levels to meet people’s needs. We received some mixed feedback about staffing levels, but our observations were that people’s needs were met. Checks were carried out to help ensure only suitable staff were employed. This process was improved during our inspection. We have made a recommendation about the recruitment process to check applicants have the right values and skills to support people safely.

People’s medicines were managed safely, and the service was working with health and social care professionals to review people’s needs and provide effective care.

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. However, the policies and systems in the service did not always support this in practice. The Mental Capacity Act (2005) had not always been consistently applied, in line with legislation and guidance.

People and their relatives spoke positively about the food provided and people’s dietary needs were met. People’s weights and fluids were monitored when a risk was identified, and action taken had resulted in positive outcomes for people.

People, relatives and professionals told us staff were kind and caring and our observations confirmed this. Staff completed training in a range of topics to support them to meet people’s needs effectively. Care plans had been reviewed and the service was continuing to make information person centred so people’s preferences were known.

Improvements had been made in the décor and furnishings of the home and further work was planned. Activities were available and people’s communication needs had been assessed and were met.

A system was in place to monitor the safety and quality of the service people received. This was being embedded into the service and actions arising were monitored and checked for completion. People, staff and relatives were asked for their views and these were being acted on. Staff told us they were well supported by managers and it was evident improvements in the service had been made. This was confirmed by people, staff and other professionals.

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 inadequate (published 23 November 2019) and there were multiple breaches of regulation. We varied the conditions of the provider’s registration to require them to submit monthly audits of the service to enable CQC to monitor improvements. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made. However, the provider was still in breach of one regulation

This service has been in Special Measures since January 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. We also followed up on action we told the provider to take at the last inspection.

Enforcement

We have identified a breach in relation to Regulation 11, consent to care and treatment. Please see the action we have told the provider to take at the end of this report.

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.

Kinross is a residential care home providing personal care to 20 people aged 65 and over at the time of the inspection. The service can support up to 29 people. Accommodation is based on two floors connected by stairs and a passenger lift. There is a range of communal areas on the ground floor including a dining room and two lounges.

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

There was a lack of effective oversight of the service by the provider, caused by inconsistent management and inadequate quality assurance processes. Some improvements identified in the action plan developed after the last inspection had not been fully addressed or sustained.

The safety of people using the service was not assured. Individual risks to people were not always managed effectively, including those relating to falls, pressure injuries and scalding. Family members expressed concerns about staffing levels and we staff rotas confirmed there were rarely enough staff to support people safely in the evenings.

The systems to investigate and report allegations of abuse were not robust and put people at risk of harm. The provider had failed to comply with the requirements of their registration as they had not notified CQC of multiple incidents of abuse.

People were not always supported to have maximum choice and control of their lives as staff had not consistently followed legislation designed to protect people’s rights and their best interests.

People told us staff were competent. However, we found the induction procedure was not robust and staff did not receive supervision as frequently as required by the provider’s policy.

Assessments of people’s needs were completed before people moved to the home, but accurate records of referrals to healthcare services were not always kept, to show they had been made promptly when needed.

Staff had built positive relationships with people and supported them in a patient way. However, they sometimes showed a lack of consideration for people and people’s privacy was not always protected.

Staff understood and met people’s needs, although care plans were not always up to date and did not support the delivery of personalised care; however, most care plans were updated during the inspection once we had identified the concerns to managers. People had not been given the opportunity to discuss their end of life wishes and preferences, although staff expressed commitment to supporting people with compassion at the end of their lives.

Medicines were usually managed safely. The home was clean and infection control procedures had improved significantly. People received enough to eat and drink. Adaptations had been made to the environment to make it supportive of the people who lived there.

Independence was promoted and people were supported to express their views. A range of activities was provided. There was an accessible complaints procedure in place and people felt able to raise concerns.

Managers sought and acted on feedback from people.

We found evidence that the provider needs to make significant improvements. Please see the key questions section of this full report.

Rating at last inspection and update:

The last rating for this service was inadequate, the report for which was published on 16 February 2019. There were multiple breaches of regulation. We issued three warning notices requiring the provider to make improvements and placed the service in special measures. The provider sent us an action plan to show what they would do and by when to improve.

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

At this inspection, we identified six breaches of regulation in relation to consent, safe care and treatment, safeguarding people from abuse, staffing, good governance, and notification of serious incidents.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Why we inspected:

This planned inspection, based on the previous rating, was brought forward due to concerns we had received about incidents of abuse, medicines management, infection control, staffing levels, risk management and record keeping. A decision was made for us to complete a comprehensive inspection to include an examination of those risks. We also followed up on the action we told the provider to take at the last inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

The home is registered to accommodate up to 29 people, including people living with dementia care needs. There were 24 people living at the home when we visited. The accommodation is based on two floors connected by stairs and a passenger lift. There is a range of communal areas on the ground floor including a dining room and two lounges.

A registered manager was not in post at the time of the inspection. 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 service was being run by a home manager who had applied to register with CQC.

We identified significant concerns about the safety of the service which put people at risk of harm. Although there was a comprehensive quality assurance system in place, this had failed to identify any of the concerns that were raised during the inspection. The duty of candour requirements were not fully followed when people came to harm.

There were not enough staff deployed, which meant people sometimes had to wait for support and staff were not always available in communal areas to support people. This also impacted on the ability of staff to meet people’s personal care needs and to effectively manage the laundry.

The laundry room was not fit for purpose and was not operated in a way that minimised the risk of infection and cross contamination.

Risks to the health and safety of people were not always managed safely. These included the risk of people developing pressure injuries, the risks posed by the use of equipment, infection risks and fire safety risks. Following the inspection, we alerted Hampshire Fire and Rescue Service to our concerns.

People’s medicines were not always managed safely. Some people did not receive their medicines as prescribed and risks relating to some medicines had not been assessed.

There were clear recruitment procedures in place, but these were not always followed to help ensure only suitable staff were employed.

Staff acted in people’s best interests but did not always record decisions they had made on behalf of people who lacked capacity.

Staff had completed a range of training relevant to their role, but training records did not confirm that all staff had completed all the training deemed essential by the provider and some training had not been effective.

We received mixed views from health and social care professionals about the support people received to access healthcare services. We found advice given by professionals was not always followed and staff were unable to confirm whether some referrals had been made.

Some adaptations had been made to the environment to make it supportive of the people who lived there, but there was a lack of signage to help people navigate around the building. Some carpets and furnishings were badly worn and there was not a plan in place for refurbishing the home.

People were offered a choice of food and drinks. Most people’s nutritional needs were met, although action was not always taken when people had lost weight.

People told us they were treated in a caring and compassionate way by staff, although a lack of staff compromised people’s dignity at times. Staff usually interacted with people in a supportive way; however, we observed two occasions where staff demonstrated a lack of consideration for people.

People were protected from the risk of abuse and staff understood their safeguarding responsibilities.

Staff respected and promoted independence by encouraging people to do as much as possible for themselves. People were involved in planning the care and support they received.

Most people’s care plans contained sufficient information to enable staff to deliver support in a personalised way. Staff demonstrated a good understanding of people’s care needs.

Family members told us staff were responsive to people’s changing needs. Staff were committed to supporting people at the end of their lives to have a comfortable, dignified and pain-free death.

People had access to a wide variety of activities based on their individual interests. People knew how to raise concerns and felt they would be listened to.

There was a clear management structure in place and care staff worked together well as a team. Staff felt supported in their role by managers.

People’s views were sought and acted on.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about the commission’s regulatory response to the breaches will be added to the report after any representations have been concluded.

Following the inspection, the provider acted quickly to identify and implement immediate changes in response to our findings. They developed a comprehensive action plan and appointed an experienced manager to implement it; they reviewed their quality assurance procedures and they consulted with architects to identify options for improving the laundry.

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.