Kimberley Court

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kimberley Court is a care home which offers care and support for up to 36 predominantly older people. At the time of the inspection there were 36 people living at the service. Some of these people were living with dementia. The service uses a detached building over three floors with a passenger lift for people to access all levels.

The current registered manager had been in post since April 2017 and had made many changes to the service provided. Staff were positive about the support they received from the registered manager. Healthcare professionals were positive about the service provided by Kimberley Court.

There were systems in place for the management and administration of medicines. People received their medicines as prescribed. The service had reported five medicine errors to CQC since January 2017. There were some gaps in the medicine administration records (MAR) where staff had not signed to show they had given a medicine. Regular medicine audits were being carried out but were not always identifying when staff had not signed MAR sheets. We were assured this would be addressed immediately.

The service held personal money for some people. This was easily accessed by people when they needed to purchase things such as hairdressing, newspapers or toiletries. Accounts were kept for each person. We checked the money held in cash which did not tally with the records, there was excess cash held. It was identified that money paid by staff and visitors for meals over the Christmas period had been added, in error, to the cash box and not recorded. This was resolved during the inspection.

Staff recorded some people’s food and fluids to ensure they had sufficient intake. However, some of these records were not clearly and consistently documented. Information in some people’s care plans was not clearly directing staff when and what to record. Action was taken by the registered manager immediately following this inspection to review, assess and stop the recording of two people’s intake as it was no longer required.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. People had their capacity assessed and best interest meetings were held and documented as required. People were asked, where possible, to sign their own consent forms. However, the service did not have an accurate record of all appointed attorneys and what powers those people held to make decisions on behalf of people living at the service. An accurate record was compiled by the registered manager the day after the inspection visit.

Equipment and services used at Kimberley Court were regularly checked by competent people to ensure they were safe to use. The premises were regularly checked and maintained by the maintenance person. There had been problems with the heating system leading to the system having extensive work carried out before Christmas. However, two people’s bedrooms were found to be cold with radiators that did not work and one which was leaking. The registered manager took immediate action to address this concern with portable heaters provided and an urgent request to the heating engineers to return to the service to address the issue.

We walked around the service which was comfortable and appeared clean with no odours. People’s self-contained flats were personalised to reflect their individual tastes. Each flat door had identifying pictures and designs to help support people who needed additional orientation to their immediate surroundings. Each lockable door had a letterbox and doorbell. People were able to have keys to their own rooms if wished. People were treated with kindness, compassion and respect.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Staff were supported by a system of induction training, supervision and appraisals. Staff meetings took place to support each team of staff as well as whole service staff meetings.

Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm. People were supported by staff who knew how to recognise abuse and how to respond to concerns.

The service held appropriate policies to support staff with current guidance. Mandatory training was provided to all staff with regular updates provided. The registered manager had a record which provided them with an overview of staff training needs.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had no staff vacancies at the time of this inspection. However, we identified that some people waited a while before staff responded to their call bells. Staff who were present in the lounge were not able to hear call bells which rang in the corridor outside. The registered manager addressed this immediately and sent us evidence of a call bell point having been ordered for installation and pagers provided to staff.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Staff were available to support people with their meals. Staff sat with people and ate together to help make the meal a sociable occasion.

Care plans were well organised and contained clear information. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff.

The environment had been enhanced with a dementia friendly ‘street’ and interactive retro train carriage, taking people on a journey on the Bluebell line complete with station stops. This had been set up in the lower floor of the service accessible to people via the lift. Reminiscence activities were supported with an old style kitchen, sweet shop, games room, photographs of film stars, old newspapers and leaflets, baby dolls and prams and a number of activities and chats supported by the staff. An activity co-ordinator was not in post but specific care staff had been provided with support to provide a range of activities on a planned basis. During the inspection people were enjoying and paying attention to a range of entertainment that took place in the lounge.

People were supported to go out supported by staff for walks or to visit local attractions. People who enjoyed gardening had been supported to grow food which had been used to compliment the menu options available at the service.

The manager was supported by a deputy manager, team leaders and a team of motivated care staff. The district manager and dementia support advisor, who also attended this inspection, supported the registered manager. There were regular audits of many aspects of the service delivery in place and the provider monitored the progress of the service against desired objectives.

This unannounced comprehensive inspection took place on 31 December 2015. The last inspection took place on 5 June 2014. The service was meeting the legal requirements at that time.

The service is a care home which offers care and support for up to 36 predominantly older people. At the time of the inspection there were 32 people living at the service. Some of these people were living with dementia. The service comprises of a detached building with three floors. People live in self contained ‘flats’ with lockable front doors.

The service had a registered manager in post. 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.

We walked around the service which was comfortable and clean with no odours. Individual accommodation was personalised to help provide people with surroundings which had a familiar feel. People were treated with kindness, compassion and respect.

We looked at how medicines were managed and administered. We found it was always possible to establish if people had received their medicine as prescribed. Regular medicines audits were consistently identified if errors occurred. However, not all creams and liquids had been dated upon opening. This meant staff would not be aware when the item had expired and would not longer be safe to use. The registered manager assured us this would be addressed immediately.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The staff group told us they had recently experienced greatly improved morale and they told us they felt they had a greater capacity to meet people’s needs. This was due to a recent decrease in the dependency of some people living at the service.

Staff were supported by a system of induction training. However, supervision and appraisals were not consistently provided to all staff in line with the service policy. More specialised training specific to the needs of people using the service was being provided. The training needs of the staff were being monitored and regular updates were provided. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

A programme of relevant activities were provided by the activity coordinator. These were mostly provided on a small group or one to one basis in order to meet people’s needs.

The registered manager was supported by a deputy manager, administrative assistant, senior care staff and a team of motivated staff. The management team at the service had good support from the provider organisation. The service was well maintained and had robust systems and processes in place to help ensure it was aware of any defects at all times. Kimberley Court was regularly quality assuring the service it provided and was constantly striving to improve.

Kimberley Court sent us an action plan in response to the compliance action. This set out how Kimberley Court had addressed the areas of concern regarding the systems and processes in place for the safe management of medicines.

This inspection looked at two areas of the service, the systems in place to ensure people were protected from the risks associated with medicines, the staffing of the home and the relationship between staff and the registered manager.

We considered our inspection findings to answer two of the five key questions: Is the service safe? and is the service well-led? We did not look at any of the other key questions at this inspection.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and looking at records.

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

Is the service safe?

The service provided residential care and support for older people some of whom had complex needs. At the time of the inspection there were 34 people living at Kimberley Court. Some people who lived at Kimberley Court were unable to speak with us due to their healthcare needs. We spoke with one person who lived at the home and one relative. We spoke with 12 staff and spent time with the registered manager reviewing the actions the home had taken in response to the compliance action.

During our inspection we found the service to be safe because Kimberley Court had taken action to ensure staff followed robust procedures when administering and managing medication.

We saw from the medication records staff recorded when people had received their prescribed medication at the correct time.

We saw the fridge used to store medication was checked daily to ensure it was working correctly and maintained the appropriate temperature for the safe storage of the medication within it.

We saw creams and lotions were dated upon opening. We saw staff dated the item itself and also recorded the date it was opened on the topical medication chart. This ensured staff knew when an item needed to be discarded.

We saw all staff who administered medication had received appropriate training in this area.

Is the service well-led?

Kimberley Court had sufficient numbers of staff to meet the needs of the people who lived there.

Staff told us they felt well supported by the registered manager and no-one reported any concerns to us. All staff reported an open culture and easy access to support whenever it was needed. Comments included 'The manager is very approachable and supportive' and 'Excellent, always there if you need anything.'

The registered manager told us the home was fully staffed. However, Kimberley Court was currently recruiting carers to increase staffing levels in the home and to further develop a 'bank' of staff who could be used to cover absences. We were told the dependency levels of people who lived at the home were monitored by the registered manager and staffing levels were adjusted accordingly.

We were told all heads of department at the home met weekly on a Wednesday to discuss all aspects of the home and its smooth running. We spoke with maintenance, catering, housekeeping and care staff, all of whom reported a good working relationship with other staff and the manager. All staff confirmed to us they worked together as a team to constantly assess and improve the service provided.

We saw the results of a staff survey carried out recently, which contained mostly positive comments and an overall improved picture compared to the last survey carried out.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. People were cared for in an environment that was safe, clean and hygienic. Care plans were individualised and contained information that directed and informed staff to provide appropriate care and support. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped to continually improve the service. Kimberley Court alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Kimberley Court had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). We saw that they were using these protections appropriately.

We reviewed the medication administration records (MAR). We saw gaps in these records. This did not ensure that people always received their prescribed medication at the appropriate time. The medication policy and procedure for Kimberley Court was not always followed. We have asked the provider to tell us how they are going to meet the requirements of the law in relation to administering people's medication.

Is the service effective?

During our inspection we observed staff caring for people. It was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

We spoke with the families of three people who lived at the home, comments included 'X is in good hands and the staff are unfailingly helpful' and 'it's a shame they don't have opportunity to be taken out, in a minibus for example'. We were told the home does not have such a vehicle to assist people to access the local community.

People who used the service, and their representatives, were involved in their care plan reviews. We saw people, or their representatives, had signed care plan reviews to show they had read and agreed to the content of the care plan.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw people were given choices as to where and when they had their meals. We saw people choosing to eat their meals in their flats; others ate in the communal dining area. People we spoke with told us 'lovely food' and 'I am quite ok here'. We saw people were able to have keys to their individual flats. This promoted people's privacy. We saw one person access their cigarettes independently and go outside to enjoy a cigarette. This showed the home promoted people's rights to make their own choices.

We saw people using the service and their relatives and friends, had been invited to complete a survey in February 2014. The responses we saw to this survey were positive.

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

Is the service responsive?

Kimberley Court had an activity co-ordinator who planned and organised activities for people who lived at the service. Many people who lived at Kimberley Court had complex health needs and were either not able, or not inclined, to join in group activities. These people were offered one-to-one occupation such as looking at photographs, reading books and reminiscence. Kimberley Court used technology in the form of an iPad to access bird songs, sound effects, music, and take pictures of art work.

We saw a file of compliments received by the service. We saw the complaints procedure clearly set out around the home on the walls. We looked at how complaints had been dealt with and found the procedure had been followed.

Is the service well led?

Kimberley Court had regular support from the district nursing team and GP's from the two local GP practices. This ensured people received appropriate care in a timely way.

We saw minutes of regular meetings held with the Team Leaders and Heads of Departments. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service. Kimberley court issued regular newsletters for people who lived at Kimberley court, their families and friends. This informed people of the results of a recent 'Your Care Rating' survey, which showed the home scored 891 out of 1000, as well as details of planned events and activity in the home. Kimberly Court had its own Facebook page on the Internet. This helped to ensure people could keep in touch with developments at the home. Staff told us they were offered relevant and useful training on a regular basis. Staff also told us they felt supported by the registered manager and could approach them at any time if they had a concern.

On the day of the inspection we spoke with five people who lived at the home. Comments included 'They (staff) are kind and caring', and 'I have no complaints'. We spoke with one visitor who told us 'X does not have enough to do during the day'. People said the food was to a good standard, and the home was always clean. We spoke with five staff who were positive about working at Kimberley court, one told us 'there is a lovely atmosphere, and we all help each other'.

People's views and experiences had been taken into account in the way the service was provided and delivered in relation to their care.

People's privacy and dignity was respected and people experienced care, treatment and support that met their needs and protected their rights.

We found that people who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse happening.

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

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

People said the food was to a good standard, the home was always clean and they felt safe living there. People said that staff were supportive and responsive to their needs.

When we inspected the home it was clean and odour free. The home was furnished and decorated to a good standard. Health and safety standards were all maintained appropriately.

Staffing levels were to a good standard. Staff were observed as working professionally with the people who lived in the home. There was evidence that suitable recruitment checks were completed. Although there were some gaps, overall, staff training was to a satisfactory standard. Quality assurance systems were satisfactory.