Karuna Manor

Karuna Manor is a nursing home providing personal care to up to 60 people.

The service provides support to older people and people living with dementia. At the time of our inspection there were 59 people using the service. The home is an adapted building across 3 floors. One floor specialises in providing care to people living with dementia. A second floor supports people with nursing needs and the third floor supports people with care needs.

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

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 leadership team and staff strived for excellence and had high standards of care. Staff provided excellent care. The service promoted an open culture which was inclusive and empowering. Everyone we spoke with praised the management team. The home had won and been nominated for many prestigious awards including a double platinum in investors in people and a world class hospitality award. This meant that people were supported by a team with high aspirations and would go the extra mile to provide excellent quality care. Robust governance systems and processes were in place to ensure all aspects of care delivery was monitored and checked for quality, driving forward improvements. The service had multiple examples of people's outcomes exceeding expectations. The provider had several examples of working in partnership with other key organisations, setting up key projects, creating champion role for dementia, inclusion, and end of life care in line with their strategies.

The service was exceptionally responsive to people’s needs. People were at the heart of everything they did. The staff team were very passionate about providing quality care. There was always a dedicated wellbeing team present this meant people could be confident that their wellbeing was always a priority. There was a wellbeing framework in place which focused on staff and people. They excelled in providing support to people at the end of their life. Families told us how well their loved ones were supported at the end of their life, people’s end of life wishes were respected by a very well-trained compassionate team. The provider had a clear complaints process in place. Everyone we spoke with knew how to make a complaint. The senior management team had excellent oversight of all processes and examined incidents in detail to ensure they learned valuable lessons.

People and relatives told us they felt safe living at the home. Medicines was managed safely overall. We have made a recommendation about medicines. People were protected from abuse because staff understood the signs of abuse and how to report it. Staff were recruited safely. People were protected from the spread of infection because staff used personal protective equipment and had training in infection, prevention, and control. Risks of harm to people were monitored and managed well.

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 14 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

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

We found the following examples of good practice.

• Due to the high risk of exposure to COVID-19 during the pandemic, the service restricted physical visits from people’s relatives except in exceptional circumstances. Individualised risk-assessments had been carried out to facilitate face to face visits, which allowed relatives to meet with their loved ones in the garden or waving through windows. Where face to face visits were not possible, the service used IT technologies such as Facetime, WhatsApp and Zoom.

• Social distancing impacted on people’s movement around the home, and therefore may have affected people’s emotional and physical wellbeing. As a result, the service introduced hall and doorway activities, such as ‘hallway bingo’, which encouraged people to participate in activities even though they were socially distanced. The service also had the televisions linked in people’s room with the temple on the ground floor which allowed people to take part in the prayer meetings without leaving their rooms.

• To minimise the risk of infection to staff, the registered provider offered staff to stay overnight at the service. As part of standard practice staff were provided with a hot meal whilst on duty. However, in addition to this, the service provided basic goods such as milk, toiletries, and bread to staff to take home free of cost for their families. Their uniforms were washed on site and this minimised the risk of staff being unnecessarily exposed to the virus.

• All guidance and the training had been translated into Gujarati, which was the main language spoken at Karuna Manor and the activity co-ordinators provided the training to people who used the service and staff alike.

Further information is in the detailed findings below.

During our last inspection on 25 October 2016 we found the provider to be in breach with regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This breach was in relation to keeping accurate and contemporaneous records and good governance.

We rated the service during our inspection on 25 October 2016 overall requires improvement.

During this inspection we found that the provider had taken appropriate actions to address this breach. For example we found that records were of good standard and provided detailed information in relation to the care provided to people who used the service. We saw that the provider had improved their quality assurance monitoring systems, which was found to be effective in addressing shortfalls and improving the quality for care for people who used the service.

Karuna Manor 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. Karuna Manor is registered to provide accommodation for up to 60 people who require nursing or personal care. Some of the people using the service may be living with dementia. During the day of our inspection 47 people were using the service. People receiving care at Karuna Manor were mostly from an Asian background.

Care and support are provided over three floors. On the ground floor were people who required residential care, on the first floor lived people who required nursing care and on the second floor lived people who had dementia care needs. The home had its own cinema, shop, beauty salon and massage and complementary therapy room in the basement. People had access to these facilities, however therapy sessions and hairdressing were not included in the overall fees and people were required to contribute additionally to them if they wished to receive these services.

Since July 2017 a new manager had been registered with the Care Quality Commission (CQC). 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 found some very good features at Karuna Manor. People lived in a purpose built environment which aimed to maximise people’s comfort, cultural background, and choice as well as people’s health and social care needs. People had access to culturally appropriate TV channels. The building was dementia friendly. The whole home had full internet access and the building was tailored around people’s independence, but without compromising their safety and security. For example, the home had CCTV in all communal areas and door alarms when people accessed the balconies Activities offered were flexible and responsive to people’s needs and the home found creative ways to engage people in activities. Consideration was given to people’s cultural, religious and medical needs when offering and providing activities.

All the people we spoke with told us they felt safe. Relatives and staff said they felt people were kept safe and cared for. We saw that the provider had processes and systems in place to keep people safe and protected from the risk of harm. Staff knew how to report any allegations of abuse and showed confidence in the senior leadership that it would be dealt with. People’s needs were individually assessed. We saw from care records that there were measures to reduce identified risks. We found there were enough staff deployed to meet peoples identified needs because the provider ensured that staffing levels were based on people’s dependency levels. People that required support with their medicine received it safely because procedures were in place to make sure this was done without harm. People received their medicines as prescribed by their doctor.

The service had taken any necessary action to ensure they were working in a way which recognised and maintained people’s rights. The staff team understood the relevance of the Mental Capacity Act (MCA) 2005and Deprivation of Liberty Safeguards (DoLS).

People were offered good quality, nutritious and culturally appropriate food. They were consulted and their wishes and choices were incorporated in the meal planning. People were supported to contact GPs and other health professionals when necessary. People told us their health was well looked after.

We observed positive caring relationships between people who used the service and staff. People’s cultural identity, religious beliefs and race was understood by staff and met in a caring way. People were involved and encouraged to contribute and make decisions about their own care and their wishes were acted upon. Staff ensured that people’s privacy and dignity was maintained and were seen to respect people if they refused care or required additional attention or support. We saw from care records that there were measures to reduce identified risks. People’s wishes were respected in regards to the support they required at the end of their life to have a comfortable, dignified and pain free death.

People’s needs were assessed and care was planned with people who used the service in mind. There was detailed guidance on how to meet people’s needs. Regular reviews were carried out so that people’s care records remained current. A complaints procedure was available. We saw where complaints had been received that this had been satisfactorily resolved.

The new registered manager provided good leadership and had a committed staff team who provided the best possible service to each person who lived at the home. The quality of service provision and care was continually monitored and where shortfalls were identified actions were taken to address the issues.

There was no registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had resigned since the last inspection and an interim manager was managing the home until a permanent manager was appointed.

At our previous inspection of 19 May 2016, we found the provider failed to maintain an accurate, complete and contemporaneous record in respect of the care and treatment provided to people using the service, people were not adequately protected from the risks of unsafe medicines, and management and quality assurance systems and processes in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people.

This meant the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan setting out the actions they would take to meet the regulation. During this inspection we found action had been taken to meet one of the regulations. Records showed appropriate arrangements were in place in relation to the management and administration of medicines. However we still found issues with record keeping and audit processes were not robust enough to facilitate improvement in the quality of care being provided.

People’s care plans were person-centred, specific to people’s needs and detailed the support people needed in various areas of their care. However, some areas were poorly written so very difficult to read. Staff were not completing daily monitoring charts accurately and these were not being checked and countersigned by a nurse or senior member of staff to ensure the needs of people were being met.

Some audits were conducted. However, they were limited to checks being undertaken. There was no effective evaluation of the quality of service being provided to people and action plans in place to enable improvement.

There was a lack of leadership in the home and poor communication with people and relatives. Unit managers for each floor were being appointed to address this.

Since the last inspection the registered manager had resigned and a number of care workers had also left. During this inspection we found the provider had taken action to reduce the use of agency staff by employing more permanent staff to ensure consistency in people’s care.

People and relatives of people using the service told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

People's care needs and potential risks to them were assessed. Risk assessments had been carried out and staff were aware of potential risks to people.

Staff were caring and knowledgeable regarding the individual choices and preferences of people. Records showed that staff had received training to enable then to carry out their roles.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. The home had made necessary applications for DoLS and we saw evidence that authorisations had been granted.

There were some activities available for people using the service. The activities plan for the home included generic activities such as ball games, exercises and bingo. However some relatives told us activities were not physically or mentally stimulating.

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

There was a registered manager in post at the time of 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

On the day of the inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff.

Relatives of people who used the service and care professionals we spoke with told us that they were confident that people were safe in the home.

People were not adequately protected from the risks of unsafe medicines management. Medicines records were not kept up to date so we could not be certain that people were adequately protected from the risks of unsafe medicines management. We found a breach of Regulations in respect of this.

On the day of the inspection staff were not rushed and were able to complete their tasks. However, feedback from people, relatives and staff indicated that at times, there were not enough staff in the home to care and support people safely. This could risk people receiving inconsistent and inappropriate care.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

People's care needs and potential risks to them were assessed. However there was limited information about the moving and handling needs of people using the service and the safety of bed rails in the home. We discussed this with he registered manager who told us he would ensure all the bed rails were checked and appropriate training would be provided to staff. He also told us risk moving and handling risk assessments for people would be reviewed.

Staff prepared appropriate care plans to ensure that people received safe and appropriate care. Their healthcare needs were closely monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.

There were records of essential inspections and maintenance carried out at the home. The service had an infection control policy and measures were in place for infection control.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes.

People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly by staff and were updated when people's needs changed. However, there were some gaps and inconsistency in the monitoring of people’s care on a daily basis.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of the person’s care in which the person’s liberties were being deprived. Records showed that some authorisations had been granted and some were awaiting approval from the local authority.

People’s spiritual and cultural values were fully respected and accommodated. The home provided vegetarian food in accordance with people’s culture. People were able to watch Indian programmes on television. Care staff were able to speak in Hindi and Gujarati which meant they were able to effectively communicate with people using the service. There was a Mandir (Hindu Temple) on the ground floor and people were supported and assisted to do their prayers and Bhajan (hymns) in the morning.

Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

There was a management structure in place with a team of care staff, nurses, kitchen and domestic staff, admin manager, registered manager and the provider. A clinical services manager had also been recently recruited. Staff had a positive attitude and were of the opinion that the service was well managed and the registered manager was supportive and approachable.

There were some quality assurance processes in place to assess and monitor the quality of service being provided and action had been taken. However, there was no effective evaluation of the issues identified. During this inspection, we found further concerns which demonstrated the current systems in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people. We found a breach of regulations in respect of this.

We made two recommendations about moving and handling and seeking advice and guidance from a reputable source about adjustments required to meet the needs of people living with dementia.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered manager to take at the back of the full version of this report.