Keer Sands Residential Home

Keer Sands Residential Home is a residential care home providing accommodation for people who require personal care. The home can accommodate 10 people. The service provides support to older people. At the time of our inspection there were 10 people using the service.

Keer Sands Residential Home is an adapted building surrounded by farms and fields. The home has 2 floors with a stair lift, lounge, dining room, an external conservatory, and a rear yard. There are 8 single rooms and 1 double room. All bedrooms have hand washing facilities with bathrooms and toilets in easy access on both floors. All rooms have a view of farms and countryside.

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

People were safe. We found systems and processes to manage risk were robust and kept people safe. People and their relatives also confirmed they felt safe. One person told us, “I can recommend it to anyone. Have no fears about this place, it’s wonderful.” All family members we talked to told us the service was safe, they had no cause for concern, and they wouldn’t have their family member anywhere else.

Medicines were managed safely. The medicines practices were good, and all medicines paperwork was current. We found the medicines storage area was also very tidy and managed well. We found 2 minor gaps in medicines practice and these were repaired during the inspection. The registered managers focused on supporting people with the least restrictive options to prevent people from being over-medicated.

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; the policies and systems in the service supported this practice.

People were protected from abuse. There were robust systems in place to keep people safe from abuse and staff were trained to respond to any abuse they might see.

Staffing was safe. We found the staff recruitment and training was good and enabled staff to support people with exceptional care.

The prevention and control of infection was good. Systems were in place and staff followed current guidance to keep people safe.

The registered managers and staff worked to learn lessons and make improvements to keep things from going wrong in future.

The whole staff team in the service ensured people were well-treated, supported, and respected. This was evident throughout the inspection. Staff were confident, skilled, and exceptionally caring. Staff were empowered to use their caring natures to improve the lives of people in the home.

People were supported by staff to be involved and express their views and making decisions about their care. This was done with empathy and was done by knowing the people well and watching for new changes in behaviours. The staff then worked to get ahead of any problems to ensure people didn’t have heightened anxieties.

All people were supported with privacy, dignity, and independence. Staff worked with people to anticipate needs and problem solve so people remained individuals and to encourage full engagement.

The registered managers promoted a positive culture that was person-centred and empowering. This led a dedicated staff team to take initiative and actively support people with very good care.

The service staff and managers worked exceptionally well with others. Other health professionals provided unanimous positive feedback regarding the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 17 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe, caring, and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to outstanding based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection in July 2015 the service was rated Good. At this inspection we found the service remained Good.

This inspection visit took place on 26 October 2017 and was unannounced.

People who lived at Keersands told us staff were kind and caring towards them. For example one person said, “They are so kind as you can see I need help and they do it so gently and confidently. They are lovely people.”

We observed during the inspection visit staff and the management team providing support to people to the bathroom and sitting chatting with them. We witnessed staff being kind and respectful throughout the day. One person who lived at the home said, “Very kind and caring people.”

Keersands had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care and when outside the building. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

The management team had sufficient staffing levels in place to provide support people required. People told us staff were responsive and available when they needed them. One person who lived at the home said, “We are a small family friendly home everyone is looked after by staff who know what they are about.”

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

The management team had systems to protect people from unsafe management of their medicines. Recordkeeping was completed correctly and we found staff responsible for medicines were trained and competency tested by regular auditing of medication procedures.

Care records we looked at were informative and reviewed on a regular basis. They were up to date to ensure people received the right care and attention.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People who lived at Keersands told us they had choices of meals and there were always alternatives if they did not like what was offered on the day. We observed at lunchtime people who required support were attended to in a sensitive, caring manner. Comments about the quality of food included, “Excellent no one can grumble.” Another person said, “The home made biscuits and cakes everyday are truly lovely.”

We found people who lived at the home had access to healthcare professionals and their healthcare needs had been met.

People who lived at the home told us they enjoyed a variety of activities and games which staff organised. These included board games, skittles and reminiscence afternoons. One person who lived at Keersands said, “I did some baking at the weekend and really enjoyed it.”

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people who lived at the home the best support possible.

The registered manager/owner had information with regards to support from an external advocate should this be required by people who lived at the home.

The registered manager/owner had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints. One relative said, “Never had to complain this is a wonderful home.”

The registered manager/owner used a variety of methods to assess and monitor the quality of the service. These included, staff and ‘resident’ meetings. In addition audits were carried out to ensure the service provided for people continued to improve and be monitored.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people living at the home, staff supporting them and from looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Keersands.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure management and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve. There had been no complaints since the last inspection.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The deputy manager had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required. They said, 'We will be looking to provide more training for staff.'

From our observations during the day, we found people were treated with respect and dignity by staff. People living at the home told us they felt safe. Comments from residents included, 'Lovely views with friendly people around to make us feel safe and secure in this home.'

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care where possible. Relatives views were also sought to ensure people received the right care to meet their needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

We spent part of the day in the lounge areas observing staff interaction with residents. People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. One resident we spoke with said, 'It's a small home which suits me and the owner and staff are so caring it's like home from home.'

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with there wishes.

Is the service responsive?

We saw literature informing people of the complaints procedure around the home. Residents we spoke with said they knew how to make a complaint if they were unhappy. The manager told us a recording system was in place to investigate, record and reach outcomes for any complaints they received. People could therefore be assured complaints would be investigated and action taken as necessary, if any issues were raised.

Is the service well-led?

Staff had a good understanding of their roles and responsibilities. People we spoke with said they received a good quality service at all times.

There were a range of audits and systems put in place in by the owner/manager to monitor the quality of the care and support being provided. This helped to ensure people received a high standard of care at all times.

During our inspection we looked at care records and spent time in the lounge with the residents observing the daily routines. We also observed breakfast and lunch being served in a relaxed unhurried manner. The home had a pleasant atmosphere with residents coming and going as they pleased. Residents comments included, 'This is a lovely place to be. I am lucky to have such a nice home with lovely staff to help me.' Also, 'The food is wonderful and plenty of it all day.'

We discussed residents care and the support they required. Staff members on duty had an awareness of residents care needs and were able to talk about the help they needed. One staff member said, 'It's a small home so we get to know people well. We can soon detect if someone has a problem or is not well.'

Staff told us they felt supported, had regular meetings with their manager, and their training was kept up to date. Staff training records we looked at confirmed this.

Prior to our visit we contacted Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

People told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs.

Residents said routines were relaxed and the standard of food was very good. They also said activities organised kept people entertained.

All responses were positive about the care and support the service provides. Comments included,

"The staff have been wonderful to me'

'No complaints, never had to the staff give us everything we want.'

'It's like a big family home. I like to have my own bits and pieces around me and they encourage me to personalise my bed room.'