CQC report explained · a residential care home
What the CQC found at Kalmia & Mallow
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk records about eating, drinking and continence were not always accurate. Some agency staff did not fully understand a person's risk plan, although there were enough staff and medicines were administered safely.
- Effective?
- Requires improvement
- This key question was not inspected during this focused inspection, so no rating was given in this report.
- Caring?
- Good
- This key question was not inspected during this focused inspection, so no rating was given in this report.
- Responsive?
- Good
- Care plans reflected people's choices and preferences. Access to activities and the community had improved, although keyworker meetings had not been held regularly for everyone in recent months.
- Well-led?
- Requires improvement
- The manager had made a positive impact, but action on refurbishment had been slow and records and quality checks did not yet give consistent oversight of the service.
What inspectors found, September 2022
Rated Requires Improvement; inspectors found kind and responsive care, but risks, records, the building and management oversight were not consistently well controlled.
Inspectors visited on three dates. The first visit was unannounced. They spoke with relatives, staff, managers and a healthcare professional. They observed care because most people could not speak with inspectors directly, and reviewed care plans, medicine records, recruitment files and other records.
The home had enough staff and medicines were managed safely. People were treated with dignity and their care plans reflected their choices. Access to activities and the community had improved, so Responsive was rated Good.
However, some risk records were inaccurate or contradictory. Agency staff did not always understand one person's risks. Parts of the building needed refurbishment, and a night-time fire evacuation had not taken place. Oversight was still inconsistent, so Safe and Well-led remained Requires Improvement.
This was a focused inspection of Safe, Responsive and Well-led. The home remained Requires Improvement, as at the previous inspection. Inspectors found enough improvement for the home to be no longer in breach of the regulations previously breached, but said further work was needed.
Safe medicines
People received their medicines as prescribed. Audits checked that medicines were being administered safely, and staff supported people to make their own decisions where possible.
“Medicines were well managed and people received their medicines as prescribed.” from the report
Enough staff
Inspectors found enough staff to meet people's complex needs and support their choices. The home was also using more consistent agency staff.
“There were enough staff to meet people's needs and enable them to make choices.” from the report
Personalised support
Care plans recorded people's goals, preferences and choices. Inspectors observed people taking part in activities that matched their interests.
“People's goals, aspirations, choices and preferences were documented in their care plan.” from the report
Improved community access
Relatives and staff said access to the community had improved. The home successfully helped one person regain funding for an activity they wanted to return to.
“The provider had advocated successfully to reinstate the funding and they had begun to enjoy this activity again.” from the report
Respect and dignity
Staff generally supported people in a way that respected their privacy, dignity and human rights.
“Staff treated people who used the service in a way which upheld their dignity, privacy and human rights.” from the report
Risk information was not reliable enough
seriousRecords about eating, drinking and continence were sometimes duplicated or contradictory. This could put people at risk, even though inspectors found no evidence that anyone had been harmed.
“Recording and monitoring of known risks was not always accurate and staff knowledge of risk was not comprehensive.” from the report
Agency staff did not always know risks
seriousActions in one person's care plan and risk assessment were not fully understood by agency staff. The provider took immediate action after inspectors raised this.
“This placed the person at an increased risk of harm.” from the report
Building and fire-safety work
seriousSome areas needed refurbishment and there had been environmental risks, including an unsafe kettle and unsecured wardrobes. A recommended night-time fire evacuation had still not happened during the inspection period.
“no fire evacuation had taken place at night even though this was a recommended action on a recent fire risk assessment” from the report
Management oversight was incomplete
needs fixingThe home had not carried out a night audit, so it lacked a full picture of people's needs across 24 hours. The provider was introducing new electronic records and planned further checks.
“no audit had not taken place at night which meant the provider did not have an accurate picture of how people's needs were met over a 24-hour period.” from the report
Some language was not person-centred
minorInspectors found some written and spoken language that was not inclusive. The provider agreed to remind staff about how they spoke to people and wrote care notes.
“Some written and verbal language needed to be more person centred.” from the report
- 01How do you now make sure every agency worker understands each person's current risks and support plan before providing care?
- 02What work has been completed on the refurbishment, including the areas affecting infection control and safety?
- 03Has the recommended night-time fire evacuation now taken place, and what did you learn from it?
- 04How are you checking that the new electronic recording system gives accurate information about eating, drinking, continence and wellbeing?
- 05What are the arrangements for the manager and the planned handover to a permanent registered manager?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their ratings were not given in this report. This explanation was written from the published report of 23 September 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2020
Rated Requires Improvement; inspectors found kind care and well-managed medicines, but serious weaknesses in personalised care, records, communication and management remained.
The inspection took place on 14 and 18 November 2019. It was unannounced on the first day, with a second day arranged. One inspector spoke with people, staff, relatives and health professionals, observed care, and checked care plans, medicines, staff records and management records.
The home was rated Good for Caring. Inspectors saw calm and respectful support, and relatives generally felt people's personal and physical care needs were met. Medicines were managed well, risks were assessed, recruitment was suitably checked, and staff understood safeguarding.
The overall rating was Requires Improvement. The home remained Requires Improvement for Safe, Effective, Responsive and Well-led. Inspectors found poor and conflicting records, weak follow-up of health needs and incidents, limited activities and community access, inconsistent staffing, and poor communication and leadership.
The home was still breaching Regulation 9 on person-centred care and Regulation 17 on good governance. Some progress had been made since the previous inspection, when there were four breaches, but inspectors said not enough improvement had been sustained.
Kind and respectful support
Inspectors saw staff supporting people calmly and patiently. Relatives generally felt staff knew people well and met their personal care needs.
“We observed staff worked in a calm, supportive way and showed great humour and patience when supporting people with their needs.” from the report
Medicines management
Staff were trained and assessed as competent before giving medicines. Daily checks helped identify whether medicines had been administered and allowed mistakes to be corrected.
“People received their medicines as intended because staff were trained and assessed as competent before being able to administer medicines.” from the report
Safeguarding awareness
Staff understood what abuse might look like and knew how to respond. Safeguarding training and opportunities to discuss concerns were in place.
“There was a good awareness of what might constitute abuse and actions staff should take to protect people in their care.” from the report
Mental capacity and choice records
The home recorded people's capacity and best-interest decisions. Staff promoted everyday choices and used the least restrictive approach described in the report.
“Best interest decisions were recorded with a clear rationale. Staff promoted choice as far as possible and were aware of people's needs and decisions were communicated with family.” from the report
Care plans and daily support
seriousRecords were spread across files, sometimes contradicted each other and were not always updated. Inspectors could not be sure staff were using all the information needed to support people safely.
“We found records contained contradictory information making it difficult for us to fully establish people's needs and how they were being met.” from the report
Limited activities and independence
needs fixingPeople did not always have structured routines, meaningful activities or regular community access. Goals were often too vague or unrealistic, and staff promoted independence inconsistently.
“People were not fully supported to undertake a range of hobbies and interests which were specific to their individual needs and preferences.” from the report
Staffing and continuity
needs fixingVacancies and regular agency staff affected continuity of care. Staff also said cleaning, cooking and administrative work reduced the time available to spend with people.
“Health care professionals commented on staff turnover which meant people had not always received continuity of care over a long period of time.” from the report
- 01How will you make sure each person's care plan is accurate, cross-referenced and updated after changes in health or behaviour?
- 02What activities and community opportunities will be available for my relative, and how will you measure progress towards their individual goals?
- 03How do you monitor fluid intake, weight, dental care and health referrals, and who checks that follow-up actions are completed?
- 04How many vacancies and agency staff are currently affecting the home, and who leads each shift when the manager or team leader is absent?
- 05How will families be involved regularly in care reviews and kept informed when staff, care plans or people's needs change?
This was a planned inspection based on the previous Requires Improvement rating and covered all five key questions, the premises and care provided, with limited observations because some people could become anxious or distressed around strangers. This explanation was written from the published report of 11 January 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Kalmia & Mallow
4 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- September 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2020Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2016GoodSafe: GoodEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Good
- June 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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13 live-in carers within about an hour of Norfolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.