Archived: Kinross

Kinross is registered to provide accommodation for up to 29 older people. There were 27 people living at the home at the time of the inspection. The home is a large property and accommodation is arranged over two floors, the ground floor offering dining and lounge areas and bedrooms. The upper floor had most of the bedroom accommodation. Bathrooms and toilets were provided on both floors. There was a lift and stairs available to access the upper floor.

Kinross is a ‘care home’. People in care homes receive accommodation and 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. We found the home to be clean and tidy throughout the inspection.

A registered manager was in place. 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.

Previous inspections of the service in July 2016 and December 2016 had identified that the service had needed to make improvements to ensure people received safe effective care and that the service was well led. Whilst improvements had been made these have not been sustained over the longer term and there continues to be further improvements required.

A quality assurance process was in place. However, this had not identified the areas of concern we found during this inspection and ensured that improvements were sustained over time.

There were not always sufficient staff provided. In the late evening and overnight there would not be sufficient staff should an emergency occur.

Records of the assessment of people’s ability to make decisions about various aspects of their care had been undertaken and best interest decisions recorded. However, the recording did not clearly show discussions with other professionals involved with the person, or their family members and when these happened.

Although medicines were usually managed safely, systems were not in place to ensure times of administration were recorded where medicines needed to be taken at regular intervals.

Systems to ensure prescribed topical creams were used safely, to ensure medicines were only given with informed consent and individual information as to when ‘as required’ medicines should be administered required improvement.

Although staff felt supported they were not all receiving regular formal supervision.

We discussed these issues and some other minor issues with the clinical lead and registered manager who were responsive to the issues raised and undertook to take action.

Recruitment practices ensured that all pre-employment checks were completed before new staff commenced working in the home although full information about applicant’s previous employment was not always known. Staff were suitably trained and although they felt supported in their work.

Where necessary Deprivation of Liberty Safeguards (DoLS) applications had been made. Equality and diversity was seen to be actively supported with people being able to express themselves.

People received the personal care they required and were supported to access other healthcare services when needed. Staff worked well as a team and with external professionals.

People received a varied diet of their choosing and meal times were sociable unrushed occasions. Infection control procedures were followed and the home was clean.

People felt safe and staff knew how to identify, prevent and report abuse. Staff offered people choices and respected their decisions. Risks to people were managed safely with plans in place to minimise risks where possible. People were supported and encouraged to be as independent as possible and their dignity was promoted. People were encouraged to maintain relationships that were important to them.

Staff were ware of people's individual care needs and preferences although these were not always documented in care plans. People had access to healthcare services and were referred to doctors and specialists when needed.

People and external health professionals were positive about the service people received.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering our regulatory response.

We undertook this unannounced comprehensive inspection on the 15 December 2016 to check the registered provider had met all the legal requirements. We found they had taken steps to address all of the breaches in Regulation which we had identified in our previous inspection, although further work was required to embed working practices in the home and sustain compliance with the Regulations. The service had demonstrated sufficient improvement to be taken out of special measures as it was no longer rated Inadequate overall or in any single domain.

Kinross is registered to provide accommodation for up to 29 older people. The home is a large property and accommodation is arranged over two floors, the ground floor offering dining and lounge areas and bedrooms. The upper floor had most of the accommodation. There was a lift and stairs available to access the upper floor. There were 22 people living in the home at the time of our inspection. The registered provider had decided not to accept any new admissions to the home following our report of July 2016.

A registered manager was in place. 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 and the manager of the service are directors of the provider company; they are referred to as the registered manager and manager throughout the report.

People felt safe in the home and told us staff knew them well and understood how to ensure their needs and preferences were met. Relatives felt their loved ones were well cared for and were safe in the home.

Risks associated with people’s care needs had been assessed although further work was required to embed this information in people’s plans of care. Whilst people had access to a system of call bells to alert staff if they required assistance this was not well understood in the home. We have made a recommendation about this.

Care plans reflected people’s care needs, likes, dislikes and preferences. Information in care plans to support the safe administration of medicines had improved and medicines were stored and managed safely.

Staff at the home had been guided by the principles of the Mental Capacity Act 2005 (MCA) when working with people who lacked the capacity to make decisions. The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the registered provider was meeting the requirements of these safeguards.

People were protected by staff who had a good understanding of the risk of abuse against vulnerable people. Staff felt confident to report any concerns they may have through the appropriate channels and had received appropriate training in this area. The registered provider had worked with the local authority to address concerns raised from our previous inspection and ensure the safety and welfare of people.

There were sufficient staff available to meet people’s needs. Processes were in place to check the suitability of staff to work with people. Staff received training to ensure they had the skills to meet the needs of people.

Staff were caring and responsive to people’s needs. They knew people well and understood how to meet people’s individual needs and preferences.

Whilst there were activities available for people to enjoy and participate in these were not always well received by people who lived at the home. The manager was considering how to improve this.

Care records were stored safely and were clear and mostly accurate. Further work was to be completed on ensuring the contemporaneous recording of daily records.

There was a programme of audits in place to ensure the safety and welfare of people. The registered manager and manager had worked with a care consultant to improve their understanding of the requirements of the Regulations and their responsibility with this.

People, their relatives and staff felt able to express any concerns they may have and have these responded to promptly. People had access to health and social care professionals as they were required. Health and social care professionals felt people were well cared for by staff who knew them well and sought appropriate support to meet people’s needs.

A registered manager was in place. 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 and the manager of the service are directors of the provider company; they are referred to as the registered manager and manager throughout the report.

Whilst people felt safe at the home and relatives had no concerns about the safety of people, risk assessments had not always been completed to ensure people received safe and effective care in the home. People’s preferences and needs were not always included in their care plans.

Staff at the home had not been guided by the principles of the Mental Capacity Act 2005 (MCA) when working with people who lacked the capacity to make decisions. The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst several people who lived at the home were subject to a DoLS and appropriate actions had been taken to support these people, staff lacked knowledge and understanding of the MCA and DoLS.

People were not always protected by staff that had a good understanding of the risk of abuse against vulnerable people. Whilst staff felt confident to report any concerns they may have through the appropriate channels, they had not received appropriate training in this area. The provider had not identified areas of concern in relation to the safeguarding of people which required further action.

There were not sufficient staff available to meet the needs of people. The provider did not have robust recruitment processes in place to ensure people were cared for safely by staff.

Whilst people found staff to be caring and supportive we observed some staff act in a way which was not caring and did not respect the dignity of people. Staff knew people at the home well.

There was a lack of stimulation in the home to encourage people to participate in activities or any offers of an alternative to people in their rooms.

People were provided with opportunities to express their views on the service through meetings and in discussion with the provider and nominated individual for the service; however people’s views were dismissed.

There was a programme of audits however it was not effective in monitoring the welfare and safety of people. The registered manager and manager did not have a good understanding of the requirements of the Regulations and their responsibility with this.

Staff who worked and people who lived at the home felt able to express any concerns they may have and have these responded to promptly. People had access to health and social care professionals as they were required.

We raised a safeguarding alert with the local authorities following this inspection as we had concerns about some areas of care at the home.

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.

We found multiple 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

One inspector carried out the inspection of this home. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service caring, responsive, safe, effective and well led?

This is a summary of what we found-

Is the service caring?

We saw people were supported in a kind, respectful and gentle manner. People told us staff were very helpful and always available. One person told us, 'If I need help they are always there, they are all lovely.' Another told us, 'They treat me very well, I can't ask for more.' Relatives told us the care their loved ones received was very good.

Is the service responsive?

People's needs had been assessed however care records we looked at were not always up to date. People we spoke with told us they received the care they wanted and staff were responsive to their needs. It was clear from our observations and conversations with people that staff knew people and their preferences well. However, people and their relatives told us there were limited planned activities for people to join in with and this meant people were not always encouraged or motivated to do activities. We spoke with the provider about the lack of activities and this was under review.

We saw the provider gathered the views of people who lived at the home, their relatives and staff to ensure they provided the service people needed and these views were acted upon.

Is the service safe?

People were cared for in an environment which was clean, however we found the provider did not have effective monitoring systems in place to ensure the risks to people of infection were minimised.

For people who were unable to consent to their care we found the provider did not act in accordance with the Mental Capacity Act 2005. We have asked the provider to tell us what they are going to do to meet the needs of people who are unable to consent to their care.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. We saw the home had applied for two DOLS since our last inspection and these were under review at the time of our inspection. The registered manager had an understanding of this process and its application.

Is the service effective?

The provider had some systems in place to monitor the quality of the service that people received. People told us they were happy with the care delivered for them and their needs had been met. Relatives told us the care their loved one received was good. We found staff training was not always up to date and the provider told us this was being addressed.

Is the service well-led?

The registered manager for this service was about to leave this position at the time of our visit. The provider was planning to support the role of the registered manager at the time of our visit. We found processes in place around the staffing of the home, policies and procedures for the care and welfare of people, and the general management of the service were under review at the time of our visit. People who lived at the home, relatives and staff were aware of these changes. During our visit, we discussed with the registered manager and provider areas of concern we had identified and they were supportive and responsive to any matters we raised.

People told us the registered manager and provider were always available to discuss any concerns they may have.

The provider wrote to us telling us that they would be compliant with this standard by 30 August 2013.

On 14 August 2013 the provider wrote to us to tell us they had met their actions and invited us to return.

At this inspection we spoke with the registered manager and two providers and inspected six people's care planning records.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were kept.

The new processes now need to be embedded and we will continue to monitor this at future inspections.

People told us they liked living at the home. One said; 'I was amazed when I first came here, everything is washed every day'. A second said; "They are very good here. The manager is lovely'.

A relative told us that their relative was involved in planning their care and their likes and dislikes were listened to and acted upon. They said; 'If I tell people my [relative] is in Kinross they say it is a nice home and I'm very lucky'. Another relative said; 'I am a fuss pot and like [my relative] to have a nice standard which [they] get here'.

People who used the service told us they felt safe and well cared for. However, care records were not accurately maintained to provide appropriate care and treatment. At the time of our inspection the provider was working to bring people's care records up to date and fit for purpose.

People were protected from the risks of inadequate nutrition and dehydration. A relative told us that their relative was always talking about the high standard of the food at the home.

There were enough qualified, skilled and experienced staff to meet people's needs.

People who used the service, their representatives and staff were asked for their views about the care and treatment and they were acted upon.