Kenton Hall Nursing Home

Kenton Hall Nursing Home is a care home providing personal and nursing care for up to 60 people, some of whom are living with dementia. At the time of the inspection there were 24 people living at the home. Bedrooms are situated on two floors with people having access to communal lounges and dining areas.

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

Medicines processes we reviewed were managed safely, with clear oversight in place regarding core processes. Training and competence assessments were up to date. Records were well maintained and staff demonstrated a good knowledge of people’s medicinal needs. The manager and clinical lead were responsive to minor areas of improvement identified on inspection.

Where people were prescribed medicines ‘when required’, some records were more person-centred than others. We have made a recommendation about this.

Activities were varied and were a vibrant blend of group activities and one to one time. The activities coordinator and other staff demonstrated a good knowledge of people’s needs, likes, dislikes and pastimes. Despite the pandemic staff had ensured people’s isolation from their community had been minimised, for instance through charity events, video calls and outdoor spaces/pod for visiting.

Care plans were electronic and contained a good level of detail in people’s records and risk assessments. Some areas contained duplication and a small number of care plans we reviewed would benefit from further review, particularly with regard to end of life care. The manager was aware of this and assured the relevant sections would be reviewed.

Staff spoke positively about the new manager and the atmosphere. The manager had worked closely with local partners to respond to specific issues and to establish clear accountable processes and systems. The nominated individual, manager and clinical lead were responsive to any suggestions made on inspection.

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 requires improvement (published 18 August 2020).

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of medicines. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the full report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

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.

We found the following examples of good practice.

¿ The home was clean and there was regular cleaning of all surfaces.

¿ The management team had worked with staff to keep the environment as homely as possible but still adhering to social distancing guidelines.

¿ Professional visitors and relatives completed health declarations and were tested for COVID-19 at the service. Risk assessments were completed prior to each visit.

¿ There was a designated visiting room and pod to allow people to have social interaction with their relatives.

¿ Staff wore appropriate PPE and had access to this throughout the home. Staff had received additional training during the pandemic about correct PPE usage and infection prevention and control.

Kenton Hall Nursing Home is a care home providing personal and nursing care for up to 60 people, some of who are living with dementia. At the time of the inspection there were 25 people living at the home. Bedrooms are situated on two floors with people having access to communal lounges and dining areas.

People’s experience of using this service and what we found. Due to the circumstances surrounding Covid-19 at the time of inspection we were unable to speak with people using the service directly. Relatives we spoke with after the inspection said they felt their loved ones were safe living at the home. They told us their family member received care that met their individual needs. One relative said “The care is pretty good. They do their best to look after my relative. She has never gone without care and is always well looked after.”

Relatives did not have any concerns regarding infection prevention and control and told us they found the home to be clean and tidy. Relatives told us they had been supported to maintain contact with their loved ones in the absence of face to face visits. Relatives told us they were able to raise any concerns and share their views with management.

During the last inspection we found improvements were required to ensure medicines were managed safely. Improvements to medicines management had been implemented since the last inspection to make sure recording was accurate and regular audits highlighted any areas for improvement. Sufficient improvement had been made at this inspection and the provider was no longer in breach of regulation 12.

At the last inspection of the service the provider had failed to ensure governance systems were sufficiently effective to monitor and improve the quality and safety of the service. Since the last inspection Quality assurance systems had been put in place to monitor the quality of service being delivered. The manager had a home improvement plan in place which identified areas for development. Sufficient improvement had been made at this inspection and the provider was no longer in breach of regulation 17.

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 service was rated requires improvement at the last inspection (published 27 August 2019). Following the inspection, the provider submitted an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 25 June 2019. During the inspection we identified breaches of legal requirements. Following the inspection, the provider submitted an action plan to show what they would do and by when to improve safe care and treatment and good governance.

We completed this focused inspection to make sure they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to two key domains, safe and well-led.

The ratings from the previous comprehensive inspection for those key domains not looked at during this inspection were used in calculating the overall rating for this inspection. The overall rating for the service therefore remains as requires improvement based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Kenton Hall Nursing Home is a residential care home providing personal and nursing care to up to 60 people, some of whom are living with dementia. At the time of the inspection there were 49 people living at the home.

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

Medicines records continued to not be effectively managed to make sure people received their medicines safely. Care records did not always provide enough details of how to support people or did not reflect their specific needs. The provider's quality assurance checks had not been effective in addressing the issues relating to medicines management and care records.

People and relatives were positive about the caring and kind nature of staff. Caring interactions were observed between people and staff. Staff had good use of non-verbal communication with people such as smiling and touch. People were comfortable with staff and enjoyed their company.

Staff knew how they would identify any signs of abuse to ensure people were kept safe. The provider had a recruitment system that reduced the risk of unsuitable staff being employed. There were enough staff on duty to support people.

Training for staff had improved since the last inspection. Staff received support and supervision to help them in their roles. Staff were familiar with people's needs.

Appropriate checks and maintenance made sure the accommodation and equipment was safe and clean.

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.

The provider and management team were committed to improving the service. The provider had invested in refurbishing bedrooms. People were involved in planning alterations to the home.

People's views were sought via residents' meetings and annual surveys. People and visitors were involved in nominating staff members for their kindness. Staff morale had recently improved but they wanted stability of management to help drive the planned improvements.

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 requires improvement (published 6 November 2018) and there were five breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of two regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe management of people's medicines and how the provider checks the quality of the service being provided. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kenton Hall Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or 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. Kenton Hall Nursing Home can accommodate up to 60 people. At the time of the inspection there were 51 people living at the service, some of whom were living with a dementia.

The service was last inspected in August 2017. At that time, we identified a breach of the regulation relating to good governance. We rated the service as requires improvement. We asked the provider to complete an action plan to show what actions they were going to take to improve. At this inspection we found that although some action had been taken to address the previous shortfalls; we identified new concerns and shortfalls resulting in a continuing breach of this regulation and additional breaches of regulations 10 (dignity and respect), 11 (consent), 12 (safe care and treatment) and 18 (staffing).

A manager had been appointed in May 2018. They had applied to register with CQC as a registered manager. However, they left employment during our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that care plans for people were not clear about the support people required and were inconsistent in the level of detail recorded. This resulted in care plans being confusing and containing contradictory material. Care staff delivered personalised care to people and had in-depth knowledge of people’s needs but this was not reflected in the documentation we reviewed. In addition, some of the language used in care plans did not promote people’s dignity.

There were shortfalls and omissions with the management of risk. Documented risk assessments were not always in place for identified risks such as diabetes.

Consent to care and treatment was not always sought in line with the Mental Capacity Act 2005 (MCA). The best interest’s decision making process had not been consistently followed for people who lacked capacity to make certain decisions themselves.

Audits were detailed and carried out monthly. However, sometimes issues had not been resolved in a timely manner. Quality assurance systems had not been effectively implemented to assess, monitor and improve the quality of the service.

We saw positive relationships between staff and people. Most people spoke positively about the activities that were on offer.

We observed staff to show people warmth, compassion and kindness at times when they required support. Most people using the service told us they were treated with kindness and respect. Staff we spoke with thought the home was caring. A visiting professional spoke of a positive working relationship and that staff were always helpful.

Safeguarding procedures were in place and staff understood their role in how to protect people. Staff were knowledgeable about what to do should they suspect or have concerns about harm being caused to people. People told us they felt safe.

The service was clean and tidy and staff followed infection control procedures.

We received mixed feedback from people and staff regarding staffing levels and some staff told us they had too much to do. Safe recruitment procedures were in place. Some areas of training that the provider had deemed to be mandatory were not up to date. Some staff told us they did not have time to complete online training while at work.

The administration of medications was not consistently safe.

Following the inspection, we wrote to the provider to request an action plan which listed what action they had taken or planned to take to address the concerns and shortfalls identified during the inspection. We also referred all of our concerns about the service to the host commissioning authorities, Newcastle Local Authority and Newcastle Clinical Commissioning Group.

You can see what action we told the provider to take at the back of the full version of the report.

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

At this inspection, due to issues with responsiveness to call bells, food on offer, record keeping and governance we have rated the service as Requires Improvement.

Kenton Hall Nursing Home can accommodate up to 60 people. Accommodation is provided on two floors of en-suite single bedrooms. A passenger lift provides access to both floors. At the time of the inspection there were 59 people using the service.

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.

The systems in place to keep people safe had been maintained. Staff had a good understanding of the safeguarding process. Accidents and incidents were well recorded and monitored to determine if any trends were occurring. Staffing levels were based on the needs of people who used the service, and were reviewed regularly to ensure safe levels. Safe recruitment processes, including pre-employment checks had been followed.

Medicines were administered by trained staff who had their competencies to administer medicines checked regularly. Medicine administration records were well completed. The home was clean and staff followed infection control procedures. We were able to easily access potentially harmful cleaning products, but the registered manager told us they would ensure these items were securely stored in future. Health and safety checks were completed however we noted fire testing had not been carried out as frequently as detailed in the provider's safety schedule.

Staff training was up to date. Staff received regular supervision and an annual appraisal.

Feedback about the food on offer was negative. It was described as processed and bland. The registered manager explained they were working towards making improvements to the meals provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Applications had been made for Deprivation of Liberty Safeguards (DoLS), where it was considered that people would be unable to keep themselves safe if they were to leave the home unaccompanied.

People had access to a range of healthcare professionals to maintain their health and wellbeing. The service had very good links with the local GP practice and was part of an initiative to reduce hospital admissions. A GP and a specialist nurse visited the service at least weekly to carry out ‘ward’ rounds. Healthcare professionals we spoke with, who visited the home regularly, were very positive about the care provided at the service.

People told us staff were warm and caring. We observed that staff knew people, their needs, and their relatives well. Relatives popped in and out of the home during our inspection and were made to feel welcome by staff.

Some people who used the service did not have English as a first language. Staff had sourced translation aids, bought DVDs filmed in their first language, and held parties and special meals in the home to celebrate events which were important within their culture. People's privacy, independence and right to a private life was promoted. The service had bought a double bed for one person so their partner could stay overnight in the home.

People and relatives told us the call bell was not always responded to in a timely way. We monitored the call bell during our visit and found most calls were answered within five minutes, but that some did take longer than this. People's needs were assessed and care plans were in place describing to staff how those needs should be met. However we found care planning and record keeping in relation to people's fluid intake was poor.

People were very positive about the range of activities on offer in the home, and the registered manager told us they had worked hard to introduce more varied activities to the home such as electronic reading devices, virtual reality and arts and crafts. These were well received.

Complaints had been responded to in line with the provider's policy, however we found assurances provided within responses to complaints had not always been well monitored. The registered manager carried out a scheduled of audits, and completed regular reports to the provider. However the quality assurance system had not been robust enough to identify and address the shortfalls which we found during the inspection. The provider had also failed to record evidence of their own quality visits to the home.

Feedback about the registered manager from staff and healthcare professionals was very good. They described the home as having strong leadership. The registered manager and staff had worked hard to maintain strong links with the local community and businesses.

We found one breach of the Health and Social Care Act 2008. This related to good governance. You can see what action we told the provider to take at the back of the full version of the report.

Recruitment issues had been addressed to ensure new staff were properly checked and vetted before they started working at the home.

The provider had not taken sufficient steps to provide care in an environment that was adequately maintained and which protected people from the risks of unsafe premises.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. However, the arrangements for carrying out checks on staff to ensure they were suitable to work with people who used the service were not adequate.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The provider also had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We found that care was planned to meet individuals' assessed needs and was delivered by enough skilled staff to ensure people's safety and welfare.

People and their relatives were very complimentary about the home, and spoke highly of the staff and the care they received. They told us, "I can't praise it enough, everything is great here"; "The care is marvellous"; and, "I'd definitely recommend this home".

All reasonable steps were taken to protect vulnerable people from being harmed. Appropriate arrangements were also in place to get people's views about the service and for making complaints.