This unannounced inspection took place on 14 February 2017. The provider of the service had changed since our previous comprehensive inspection; therefore this inspection was a first rating inspection for the service. Kents Hill Care Home is located in a residential area of Milton Keynes and is registered to provide accommodation and personal care to people who may or may not have nursing care needs. They provide care for older people who may also be living with dementia and can accommodate up to 75 people at the service. When we visited there were 55 people living at the service.
The service 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.
Staff members did not always receive effective support and training to perform their roles. Staff had not received regular supervision and had not been able to discuss any concerns they had about people's care, the service or their own development needs. Some staff members struggled with the electronic training system in place, however; had not had the opportunity to discuss this or seek alternative training methods. The provider had identified this issue and was working to resolve it.
Consent to care was sought on a daily basis but was not evidenced in people's care plans. It was not clear whether or not people agreed with the arrangements in place for their care, treatment and support. There were not robust systems in place to ensure the Mental Capacity Act 2005 (MCA) was used to support people who were unable to make decisions for themselves, or to show that decisions had been made in people's best interests. Provider checks had highlighted this concerns and work was underway to drive improvements in this area.
People's care was not always person-centred. Care plans did not show that people had been involved or consulted in their care arrangements. They were basic and did not provide staff members with sufficient detail to ensure they were able to provide care and support in accordance with people's needs and preferences. Staff members had individual knowledge of people at the service, but the current systems did not enable staff to record and share this knowledge with the rest of the team. There were activities for people to enjoy, however; the resources for this did not always ensure that all people were able to take part in activities. The new provider was working on making improvements in these areas.
Recent changes to the provider had unsettled some members of staff. They were not fully aware of the changes which were taking place, or what the future may hold. However; staff members still maintained a positive ethos and were motivated to provide people with the care and support they needed. They looked out for the people they cared for and were prepared to do the right thing for them.
There were quality assurance procedures in place at the service, but these had not always been effective in identifying areas for improvement. The provider had identified this and introduced a range of new checks and audits when they took over. The registered manager had worked to implement these new systems however; this had impacted on their visibility and availability to members of staff. They had however; worked hard to ensure they were still available to people and their families. Feedback and complaints were also welcomed and there were systems in place to record these and take appropriate action.
Staffing levels at the service were sufficient to ensure that people's assessed needs were met however; at times staff were very busy and became stretched. This meant that they were not always able to perform all aspects of their role. The recruitment procedures in place were robust and ensured that staff were suitable for their roles.
People felt safe living at the service. They were cared for by staff who were aware of abuse and the signs it may take. Staff were prepared to take action to reduce the risk of abuse and to report any incidents or concerns appropriately. There were systems in place to manage risks to people, visitors and staff and steps were put in place to reduce the likelihood that risks would occur. Systems were also in place for the safe storage, administration and recording of people's medicines.
The service provided people with a healthy and nutritious diet. People had a choice of what they wanted to eat and alternatives were provided where necessary. Support with eating and drinking was provided where necessary and specific dietary or cultural needs were accommodated. People were also supported to be at as good health as possible and the service assisted with appointments with a range of different healthcare professionals.
There were positive relationships between people and members of staff. Staff worked hard to get to know people and made sure they treated them with kindness and compassion. People and their family members were involved in the running of the service to ensure they were happy with the care they received and staff upheld people's dignity and respect whilst performing their roles.
We identified that the provider was not meeting regulatory requirements and was in 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 the inspection report.