Archived: Keep Hill Residential Home

Keep Hill is a residential care home registered to provide personal care and accommodation to nine people over 65. However, at the time of the inspection the service was providing care to a person under 65. The Statement of Purpose had not been updated to reflect the change in the service user band and we were not notified accordingly of the change in the service user band.

The service is owned and managed by an individual and is one of two homes run by the same provider.

At the time of the inspection nine people were living at the service. People’s bedrooms were both on the ground and first floor. Five bedrooms have en-suite facilities and four people share shower rooms. People have access to communal facilities of the sitting /dining room.

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

A person told us their experience of living at the service was “okay”. Another person told us they hated it, felt disliked and had nothing in common with the people living there. A relative was happy with the care their family member received, although acknowledged the service looked “tired”.

Safe care and treatment was not provided. People were not safeguarded from abuse and risks to them were not managed. Safe medicines practices were not promoted. Accident and incidents were not appropriately managed and there was no system in place to learn from incidents and prevent reoccurrence.

The staffing levels were not sufficient to ensure staff were not working excessive hours and changes in people’s needs had not resulted in a review of the staffing levels. Staff were trained but the training was not effective to enable them to deliver safe and effective care. Staff were not supported in line with the provider's policy and daily practices were not monitored and poor practice was not addressed.

The environment of the service was not fit for purpose. The service was not suitably maintained and furniture and furnishings were broken, and unhygienic. People were assessed but the assessment failed to identify their needs and how they could be met. Person centred care was not provided and people’s communication needs were not identified and met. Activities were provided but access to community-based activities was limited. The service had not established community links to benefit people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People's privacy and dignity was not consistently upheld.

People’s health and nutritional needs were identified but records were not suitably maintained to show how these were met. Records were not suitably maintained or secure.

The service was not effectively managed or audited. The registered manager failed to make the required notifications to CQC to inform us of events and changes within the service. They failed to bring about the required improvements to the service and had not identified other improvements were required.

The service had a consistent staff team and they knew people well. Some staff were generally kind and caring but their engagement with people was not always appropriate and show the required level of respect.

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 14 February 2019). The service has been rated requires improvement for the last four consecutive inspections. At this inspection the rating had deteriorated further.

The provider has been in continued breach of Regulation 17 for the past three inspections and in breach of Regulation 12 for two inspections, in 2016 and 2019. At the previous inspection in February 2019 positive conditions were imposed on the providers registration in respect of breach of Regulations 17. The provider/registered manager sent us monthly updates on the progress within the service, which was an overview of what had taken place in the service each month. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to the management of risks, medicines, staffing levels and their training and support, the environment, level of cleanliness, consent, dignity and respect, person centred care, records, governance and notifications.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Keep Hill Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The home is registered to provide care for up to nine older people and people with dementia. Nine people were living there at the time of our visit.

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.

Relatives were complimentary of the care provided. Their comments included “The staff are good, it is nice. There are no agency workers and most of the staff have been here for a long time, so they get to know the people.” Another relative said “(Name of person) has only been a resident here for a few weeks but they have settled really well. I am really pleased and it has made life so much better for me, too.”

People said they felt safe at the service. Staff had undertaken training on safe working practices, such as safeguarding and moving and handling. Risk assessments had been written, to reduce the likelihood of injury or harm to people during the provision of their care. Evacuation plans had been written for each person, to help support them safely in the event of an emergency, such as a fire. Equipment was serviced to make sure it was in safe working order. We have asked the registered manager to look at replacing the passenger lift, due to several breakdowns this year. We have made a further recommendation for the service to purchase its own equipment to maintain floors in a hygienic condition, rather than hire it.

People’s medicines were kept secure and records were maintained when staff had administered these. However, the home did not always ensure new prescriptions were obtained in time, to ensure people received regular courses of medicines.

We found there were sufficient staff on duty, to meet people’s needs. However, the home did not have a cook in post. Care workers were preparing meals as well as supporting people with their personal care. We have made a recommendation about this.

Staff were recruited using robust procedures, to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through induction, supervision and appraisal. There was an on-going training programme to make sure staff had the skills they needed to support people.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. People were supported with their healthcare needs.

People were not supported to take part in many activities or to have links with the local community. There was a vacant activity organiser post at the home, which had been advertised. Staff were providing activities, where they could, in the meantime. A church service used to be held at the home but there was no current provision to meet people’s religious needs. We have made a recommendation about this.

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.

We looked at whether the service ensured people had access to the information they needed, in a way they could understand it. This was to comply with the Accessible Information Standard. The Accessible Information Standard is a framework put in place from August 2016, making it a legal requirement for all providers to ensure people with a disability or sensory loss can access and understand information they are given. We have recommended work is undertaken to comply with this standard.

Monitoring and audits were carried out at the home. However, the registered manager did not always take action to improve the service or to ensure continuity of people’s care.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines practice and governance of the service.

You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Keep Hill Residential Home is a care home providing personal care and accommodation for up to nine older people. At the time of our inspection there were six people living at the service. However, on the day of inspection there were four people in residence at Keep Hill Residential Home. One person was in hospital and the other person was on holiday with their family.

There was 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.

People and the relative we spoke with felt people were safe at Keep Hill Residential Home. Staff understood their responsibilities in relation to safeguarding people. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. People and the relative were involved in their care and people’s independence was actively promoted. Relatives and staff told us people’s dignity was promoted.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where possible.

There were sufficient staff to meet people’s needs. The staff rota book confirmed planned staffing levels were maintained. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable to undertake their care role.

People told us and we saw they had enough to eat and drink. People were given a choice of meals and their preferences were respected. Where people had specific nutritional needs, staff were aware of these, and ensured these needs were met.

We saw the complaints procedure was accessible to people and the relative we spoke with told us they knew how to raise any concerns and were confident they would be listened to.

The relative we spoke with told us they were confident they would be listened to and action would be taken if they raised a concern. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

Staff spoke positively about the support they received from the deputy manager, the registered manager and all of the team at the home. Staff supervision and other meetings were scheduled and took place regularly. People, the relative we spoke with including staff told us all of the management team were approachable and there was a good level of communication within the service.

People told us the team at Keep Hill Residential Home was very friendly, responsive and well managed. The service sought people’s views and opinions and acted on them.

The deputy manager had commenced work at Keep Hill Residential Home in November 2016. They were in the process of looking at systems and enhancing the quality of these systems. They had introduced audits of medicines, but these were not always being completed. The registered manager did not have a system in place to monitor the quality of service delivery to people. The registered manager had failed to take appropriate action to correct this.

We found a continued 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 report.

We previously inspected the service on 05 and 06 March 2015. The service was not meeting all the requirements of the regulations at that time. We found deficiencies with how hazards were managed, in the recruitment of staff, cleanliness and infection control practice, recording of decisions made in people’s best interests and quality assurance systems. The provider sent us an action plan which outlined the improvements they would make. During this visit, we checked to see whether these improvements had been made.

Keep Hill Residential Home provides support for up to nine older people. The home was full at the time of our inspection with six permanent residents and three people who were staying for respite care.

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.

We received positive feedback about the service. Comments from people included “I’m very happy here,” “They’re very good” and “I’m certainly well looked after.” Healthcare professionals told us staff listened to and implemented any advice or recommendations they made about people’s care. One told us “I can’t praise them enough.”

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns.

We found there were sufficient staff to meet people’s needs. Improvements had been made to ensure staff received appropriate support through regular supervision and appraisal of their performance. There was an on-going training programme to provide and update staff on safe ways of working. Policies and procedures had been updated to make sure staff had up to date guidance to refer to.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. Improvement had been made to show how decisions were made on behalf of people who lacked capacity, in accordance with the Mental Capacity Act 2005.

Staff supported people with their healthcare needs to keep them healthy and well.

We found improvements had been made to infection control practice to help prevent the spread of infection at the home.

There had not been any complaints about the service. People knew how to raise any concerns and were relaxed when speaking with staff and the registered manager.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to assessing and mitigating risks to people’s health and safety, recruitment practice, monitoring and assessing the quality of people’s care and record keeping. We also found the provider had not fully implemented the actions they said they would take following our last inspection.

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

People told us they felt they received good care and were happy living at the home. One person told us 'I am very happy here, the home meets my needs.' A relative we spoke with told us '(X) is very happy here; when I come I see (X) looks very good.'

We found people's needs were assessed and care and support was planned and delivered in line with their individual care plan. Care records we reviewed were person-centred and informative.

We found people were cared for, or supported by, suitably qualified, skilled and experienced staff. People described staff as "Polite", "Caring" and "Understanding.

People were made aware of the complaints system. People we spoke with were confident about raising any complaints if they had a concern. One person told us 'I have not had to make a complaint, because I have no reason do so.'