Kinloch Tay Residential Care Home

Kinloch Tay is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Kinloch Tay is a care home which provides accommodation for up to 21 people. At the time of our inspection, there were 20 people living in the home. This home provides a service to older people, including people living with dementia, a sensory impairment, a physical disability or a mental health need. The service was arranged over two levels, and connected via a passenger lift and staircase. There was a mix of single and double bedrooms, most of which had en-suite facilities available. There was an accessible bathroom and toilet on each floor as well as a single toilet on the first floor. Communal facilities included a large lounge, a dining room and a secure garden area that people could easily access.

There was a registered manager at the home. 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.

At our last inspection in October 2017, the service was rated ‘Requires Improvement’ overall and we identified breaches of Regulations 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People’s rights were not protected in line with the Mental Capacity Act 2005 and risks to people were not always identified and assessed to ensure their safety. We also identified a breach of Regulation 18 of the Registration Regulations 2009. The registered manager had not notified the CQC of all incidents involving people living at the service. At this inspection, we found action had been taken to address these issues, and there were no longer any breaches of regulation.

Individual and environmental risks were managed effectively. Risk assessments identified risks to people and provided clear guidance to staff on how risks should be managed and mitigated.

Staff were knowledgeable of the Mental Capacity Act 2005 and people’s rights were protected in line with the Act at all times. Where people were required to be deprived of their liberty, this was completed and recorded in an appropriate and timely manner.

People felt safe living at Kinloch Tay. Staff knew how to keep people safe and how to identify, prevent and report abuse. They engaged appropriately with the local safeguarding authority.

Thorough staff recruitment checks were carried out when a new staff member started working for the service. There were enough staff available to keep people safe at all times and staffing levels were monitored by the registered manager.

There were robust systems in place to ensure the safe management of medicines. People were supported to receive their medicines by staff who had been trained appropriately and medicine administration records were completed accurately.

Staff received a variety of training and demonstrated knowledge, skill and competence to support people effectively. Staff were supported appropriately by the registered manager and deputy manager.

People were supported by staff with their nutritional and hydration needs. People were offered choice at mealtimes and menus contained a variety of nutrition and healthy foods. Where people had specific dietary requirements, this was well documented and staff were aware of how to meet these needs.

People had access to health and social care professionals where required and staff worked together co-operatively and efficiently.

People were cared for with kindness and compassion. Staff had developed positive relationships with people and their relatives and knew what mattered most to them.

Staff took action to protect people’s dignity and privacy at all times and encouraged people to be independent with all aspects of their daily routines where possible.

People had a clear, detailed and person-centred care plan in place, which guided staff on the most appropriate way to support them. People’s families were invited to be involved in the planning and delivery of their relatives care where appropriate.

The service had a clear process in place to deal with complaints and we saw that concerns were dealt with in a timely and effective manner.

People had access to a variety of activities to ensure they received appropriate mental and physical stimulation, and were encouraged to follow their own interests.

People, their relatives, visitors and staff members commented positively on the leadership of the service and felt that the service was well-led. The provider was engaged with the running of the service and was approachable to people and staff.

There were appropriate auditing systems in place, which ensured that issues were acted upon and ideas for improvement were responded too.

The home had a registered manager. 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.

Systems in place to manager risks relating to the health and safety of people using the service had not ensured that all risks were assessed or reassessed and action had not always been taken to reduce identified risks to ensure the safety of people.

Records of the assessment of people’s inability to make informed decisions had been undertaken. However, there was no record to show why subsequent decisions to provide care or restrictive practices were in the person’s best interest and had been discussed with relevant others as is required by mental capacity legislation.

A quality assurance process was in place. However, this had not identified the areas of concern above or other aspects of the service. Staff were not always following safe procedures when they assisted people to reposition. Action had not always been taken to ensure the safety of people from the actions or potential actions of other vulnerable people. Although staff were aware of the risks posed to people from care staff working with long acrylic finger nails no action had been taken to prevent staff having these.

Medicines were usually managed safely although systems were not in place to ensure times of administration were recorded where medicines needed to be taken at regular intervals. Otherwise there were appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines.

People felt safe and staff knew how to identify, prevent and report abuse. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

Care plans provided individual information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. People had access to healthcare services and were referred to doctors and specialists when needed.

People were encouraged to maintain relationships that were important to them. Kinloch Tay Residential Care Home was animal friendly and people were able to bring their pets with them when they moved in.

There were enough staff to meet people's needs. Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and external health professionals were positive about the service people received. Most people were positive about meals and they were supported to eat and drink when required.

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. Visitors were welcomed and there were good working relationships with external professionals.

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

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

The inspection was unannounced and was carried out on 29 July 2016 and 04 August 2016.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their families told us they felt the home was safe. However, medicines were not always managed safely. The system for recording and storing medicines was not robust and led to inconsistencies which could lead to confusion as to whether a person had received their medicine or not. Staff did not have access to guidance to help them understand when ‘as required’ (PRN) medicine should be given. By the second day of our inspection the registered manager had taken action to resolve these concerns.

Staff sought verbal consent from people before providing care. However, the assessment of people and decisions made in their best interest were not always recorded to help staff understand the person’s ability to make decisions for themselves or why a decision had been made. By the second day of our inspection the registered manager had taken action to resolve these concerns.

Legislation which allows people to be deprived of their liberty in their best interests was not followed and people were deprived of their liberty without it being legally authorised.

Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. Staff were responsive to people’s communication styles and gave people information and choices in ways that they could understand.

People were encouraged to maintain relationships that were important to them. The home was animal friendly and people were encouraged to being their pets with them when they moved in.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for people and their families to become involved in developing the service. They were encouraged to provide feedback on the service provided both informally and through ‘resident meetings’ and an annual questionnaire. They were also supported to raise complaints should they wish to.

People’s families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. The provider was fully engaged in running the home and provided regular support to the registered manager. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

We found a breach 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.

We looked at six care plans and saw they were individualised and included the necessary information to inform staff as to the specific care people required. We saw these were reviewed on a monthly basis. We observed care in the communal areas of the home and saw staff interacting with people in a positive way. One member of staff said 'The people here are like your family. I treat them how I would like my mum and dad to be treated'.

We saw the home was clean and well maintained. The manager told us they were responsible for overseeing infection control. We spoke with three members of staff and the manager, all of whom said they had received infection control training. Everyone we spoke with told us the home was always clean.

We saw there was enough qualified, skilled and experienced staff available to meet people's needs. We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Observation during the inspection showed staff supporting people to make their own choices about what they had for lunch and what activities they took part in. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas listening to music and interacting with each other. During our inspection we observed people spending time in their bedrooms having their hair cut and styled and talking to family members. We also saw people being involved with activities in the lounge with staff members.

During the inspection we observed staff spending the majority of their time with people who used the service. They frequently checked on them to ensure they were alright when spending time on their own.