About the service:

Kimberley Care Village is a residential care home, it is registered to provide personal care for up to 68 older people some of who may be living with dementia. There were 56 people living at at the home at the time of the inspection.

People’s experience of using this service:

• People told us they were happy living at the home and that staff were kind and friendly. One person told us, “They are all nice to me and so friendly and they are kind to all of us. This is not just a job to them. They definitely want to support us as best as they can and make it a pleasant environment.”

• Relatives were also happy with the care provided. They spoke about how caring the staff were and well led the service was. One relative told us, “I always arrive unannounced. When mum first moved here I thought maybe she should move nearer to us, but the care is so good and I have visited others. I have 100% trust in the care here.”

• There were enough staff to meet people’s needs and they received the training and support needed to provide safe care to people in line with best practice. Recruitment processes ensured that staff were safe to work with people living at the home.

• Care plans contained all the information staff needed to provide care that was tailored to people’s individual needs. Risks to people were identified and care was planned to keep them safe. Where needed equipment was in place to support people’s well-being. Medicines were safely managed, and the environment was clean.

• The provider had recently introduced home cooked food into the home and people told us that this had improved the quality of the food. The success of this was reflected in the decrease in people at risk of malnutrition.

• The provider was refurbishing the home to improve the environment for people. Areas of the home which had been completed were of a high standard and supported people’s well-being. The dementia unit was planned to be refurbished and the provider was aware of best practice in providing a dementia friendly environment for people.

• Systems in place to monitor the quality of care provided and to drive improvements in care were effective. The registered manager ensured that they stayed up to date with changes in legislation and best practice guidance and worked with other healthcare providers to improve people’s experience of care.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (report published 07 July 2017). At this inspection we found the provider and registered manager had made the necessary improvements.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about this service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

The inspection took place on 28 February and 1 March 2017 and was unannounced.

The home is registered to provide residential care for 68 older people or people living with a dementia. The home was split into four areas called The Willows, The Beeches, The Laurels and The Oakes. Two of the areas were specifically for people living with a dementia and had secure access so people could not leave independently. There were 54 residents living at the home on the day of our inspection.

There was a registered manager for 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 home is run.

We have made a recommendation about ensuring the audit system is effective.

Staff were supported to develop the skills needed to provide safe care. There were enough staff to provide person centred care for people during the day, however at night care became more task focused and did not fully support people. The registered manager had appropriate systems in place to ensure staff were safe to work at the home and staff had received training in how to keep people safe from abuse.

Most risks to people had been identified and care planned to keep people safe. However, people’s care needs around their skin were not consistently recorded. While most medicines were safely managed there was a lack of consistency and recording around medicines prescribed to be taken as required. People were supported to access a choice of food and drink but people’s fluid intake was not consistently recorded.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. The registered manage had made appropriate referrals to the DoLS authority for people who were unable to make a decision about where they lived. In addition staff supported people to retain their independence and make decisions for themselves. Where this was not possible they protected people’s rights by using capacity assessment and best interest decisions in line with the MCA.

There were kind and caring relationships between people who lived at the home and the staff. Staff supported people to make choices about their everyday lives and to maintain their independence. People were supported with some activities but the registered manager had identified that this needed improvement and had taken steps to increase the activities available to people.

The registered manager was approachable for people living at the home and staff. They had taken steps to improve the culture of the home so that staff were more confident in their roles and felt more able to raise concerns. People were happy to raise complaints and the registered manager dealt with them in line with the provider’s policy.

The inspection took place on 3 December 2014 and was an unannounced inspection. The home had last been inspected in April 2013 and at that time was found to meet all the legal requirements we looked at. There were 48 people living at the home.

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 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 home provides residential and nursing care to older people and people living with a dementia. The home was set out over two floors and was registered to provide care for 72 people. However, the registered manager was in the process of creating smaller lounges for people to sit in and so currently the home can only accommodate 58 people. One area of the home was called The Willows and this was a secure unit for people living with dementia.

We found a number of breaches 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.

People’s safety was compromised in a number of areas. We saw care was not always planned in a way which would protect people from harm. Furthermore, we saw that where care was appropriately planned staff did not always deliver care in accordance with people’s care plans. Systems to support staff to administer medicine were not embedded or kept up to date which increased the risk of a medicine error.

While staff responded quickly in an emergency the current staffing levels did not allow staff to always meet people’s needs in a timely manner. Staff were very task orientated and focused on getting the task completed and did not always have the time to personalise care to meet people’s individual needs. Staff training did not always cover all the area’s staff needed to develop their skills in. Where training was in place staff did not consistently demonstrate appropriate skills while caring for people.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. People who were at risk of having their liberty deprived had their rights protected by a senior staff team who had received appropriate training. However, where people were unable to make decisions for themselves the systems in place to make decisions for them did not always meet the requirements of the Mental Capacity Act 2005 (MCA).

People were not always supported to have a choice of meals and were not positive about the food. We saw people were not supported to eat their meals while they were warm and a staff did not enquire about why people had not eaten much food. People were not always supported to have continuous access to drinks.

People told us about and we saw some good examples of care. However, this level of care was inconsistent and we observed some poor levels of care. This meant that people could not be assured that the level of care they received would fully meet their needs. In addition, the records we looked at highlighted there were concerns with the quality of service provided. People said they would like more support with activities and pursuing their hobbies. We found people in the dementia wing had less opportunity to take part in activities and hobbies than people in other parts of the home.

The registered manager had identified a number of areas for improvement, they were in the process of employing a deputy manager and more care staff to improve the quality of the service provided. Staff said the registered manager was supportive and they were happy to raise concerns with the registered manager and were confident they would be dealt with. Staff said there had been lots of positive changes to the home recently. However, we found that the care was not person centred and staff did not always take account of people’s wishes and needs when providing care. The systems in place to review the quality of service provided to people did not identify areas of concern. Incidents and accidents were not routinely analysed to identify if changes were needed to improve the level of care provided.

The inspection took place on 3 November 2015 and was an unannounced inspection.

Since our previous inspection on 3 December 2014 the provider had ceased to provide nursing care from this home. The home provided residential care to older people and people living with a dementia. The home was set out over two floors and was registered to provide care for 68 people. However, the manager told us that there was only space for 64 people. One area of the home was called The Willows and this was a secure unit for people living with dementia.

There was a manager at the home; however, they had not completed their registration with us. 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 previous inspection on 3 December 2014 we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that there were not enough staff to support people effectively and staff did not receive effective training. Medicines were not safely administered and people were not fully supported against the risks associated with inadequate food and hydration. Care was not fully planned to keep people safe and meet their needs and people were not treated with consideration and respect. Systems to assess and monitor the quality of the care and identify, assess and manage risks were ineffective.

At this inspection we found the provider had made the necessary improvements and was no longer in breach of any regulations.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. Where people may lack the capacity to make decisions for themselves capacity assessments had been completed. Where people were unable to make decisions, these had been taken in their best interests after obtaining their views of friends, relatives and health and social care professionals. Where people were at risk of being deprived of their liberty they had been appropriately referred to check if a DoLS was needed.

There were enough staff to meet people’s needs. Staff had received appropriate training and support to provide safe care to people which met their needs. However, this was not always fully embedded in their work. Staff were able to identify how people may be harmed and knew how to report any harm to their senior care staff of manager. However, they were not always aware of how to raise concerns with external organisations.

Care plans recorded risks people were exposed to while receiving care and the action to be taken to reduce the risk. In most cases care was delivered in line with the care plans to keep people safe. However, lack of understanding of pressure relieving equipment by care staff in the dementia unit meant people were not fully protected from the risk of pressure damage. Care plans were structured so information was easy to find and most contained information needed to keep people safe. However, care plans for people in the dementia unit did not contain information on when to administer medicines prescribed to be taken as required or around diabetes care.

People’s medicines were ordered, stored and disposed of safely. Staff had received training in how to administer medicines safely and we saw they followed that training. However, urgent medicines were not always obtained in a timely manner.

The care provided met people’s needs and was delivered at a pace appropriate for the person being supported. Care staff and other staff were kind and respectful to people receiving care. People were offered choices in their everyday lives and were involved in decisions about their care. Activities were provided and people had the opportunity to be involved in planning activities for the home.

The mealtime experience was pleasant and planned. Nutritional assistants supported people to eat and people’s nutritional needs were identified. People had been appropriately referred to health care professionals for advice and support.

The manager had improved the culture in the home and staff identified that they trusted and respected the manager. Staff were focused on providing person centred care and felt supported to do so. The systems in place to monitor the quality of care provided were effective and people living at the home and their relatives had been able to evaluate the service they received.