Background to this inspection
Updated
5 May 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
Koinonia Christian Care is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Koinonia Christian Care is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced. Inspection activity started on 24 March 2022 and ended on 29 March 2022. We visited the location’s service on 24 March 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with six people who used the service about their experience of the care provided. We spoke with seven members of staff including the nominated individual, registered manager, senior care workers, care workers, kitchen assistant and the administrator. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with the operations manager of the new provider.
We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at policies and procedures and care documentation. We spoke with four relatives of people who use the service, four staff members including care workers and the chef.
Updated
5 May 2022
About the service
Koinonia Christian Care is a 'care home'. The home accommodates up to 39 older people with dementia or age-related physical frailties across five adapted buildings. The service is a care home which supports people with Christian beliefs. At the time of the inspection there were 30 people living at the service.
People’s experience of using this service and what we found
Quality assurance processes were not routinely completed to ensure effective provider oversight of the running of the service. Analyses of incidents and accidents had not been carried out to establish risks, trends and patterns to allow continual learning to improve care.
People’s health risks were not always appropriately assessed, care plans were inconsistent and out of date to guide staff on how to meet people’s needs. This included providing safe support with swallowing difficulties, weight loss and catheter care.
People were not always supported by enough staff. Staff deployment meant some people with higher needs were not supported in a timely way. We saw where people required assistance at mealtimes, there were not enough staff in the unit to support them. The registered manager covered shortfalls on the rota. People told us they were aware of the shortages and told us staff were doing their best.
People were kept well informed of the changes within the service. A new provider was due to take over the running of the service. People and their relatives were able to ask questions in advance of this happening. One relative told us, “It's interesting to see what will happen with the new ownership. It's an independent caring family situation and I hope that doesn’t change.”
People were kept safe by staff who understood their responsibilities to recognise and report safeguarding concerns. People received their medicines in a person centred and timely way, staff were trained and assessed as competent before administering people’s medicines.
People spoke highly of the support they received. People told us they enjoyed the food and the staff were kind the them. Comments included, “The staff are excellent, I am glad I am here. I feel well cared for.” And, "It's a lovely place to be, I am happy, I have my friends, my health."
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.
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 4 May 2020).
Why we inspected
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.
The inspection was prompted in part by notification of a specific incident, following which a person died in hospital after a choking episode at the service. This incident is subject to an 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 risks and governance of the service. This inspection examined those risks.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Koinonia Christian Care on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to assessing and managing risks and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the new 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 continue to monitor information we receive about the service, which will help inform when we next inspect.