CQC report explained · a residential care home
What the CQC found at Keyll House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- Inspectors found that people were protected from abuse, risks were assessed and medicines were managed safely. There were staffing shortages, and on some occasions staffing levels did not meet people's needs.
- Effective?
- Good
- This question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused inspection. The report nevertheless describes staff as kind and respectful.
- Responsive?
- Requires improvement
- People did not always have enough opportunities to go out, follow their interests or take part in meaningful activities. Staff sometimes used directive language rather than offering choices.
- Well-led?
- Requires improvement
- Staffing vacancies and unstructured support had affected people's outcomes for several months. The home had some effective audits and improvement plans, but management had not yet resolved the main problems.
What inspectors found, June 2022
Rated Requires Improvement; inspectors found safe, kind care, but staffing problems limited community activities and management needed to improve.
This was an unannounced focused inspection on 25 March and 19 April 2022. Inspectors checked Safe, Responsive and Well-led after concerns about safety and access to meaningful activities. They spoke with a person using the service, relatives, staff and other professionals, and reviewed care, medicine, staffing and management records.
The home was rated Good for Safe. People were protected from abuse, risks were assessed, medicines were managed safely and staff were recruited with appropriate checks. There were staffing vacancies, however, and on some occasions there were not enough staff to meet people's needs.
The home was rated Requires Improvement for Responsive and Well-led. People did not always receive enough support to go out, follow their interests or have meaningful activities. The provider had identified problems and planned changes, but inspectors said these improvements had not yet taken effect.
The overall rating fell from Good at the previous inspection, published on 18 September 2019, to Requires Improvement. This inspection did not review Effective or Caring, so those ratings were not reassessed.
Safeguarding
Staff understood how to recognise and report abuse. The management team acted on safeguarding concerns and made changes to people's support.
“Staff received safeguarding training and knew how to report safeguarding concerns to the local authority, CQC, and other agencies as necessary.” from the report
Risk management
People's individual risks were regularly assessed. Care plans gave staff detailed information about how to support people safely.
“Risks to people were regularly assessed and monitored. Detailed risk assessments and care plans were in place, so staff knew how to support people.” from the report
Medicines
Medicines were ordered, stored and disposed of appropriately. Staff were trained and their competence was checked.
“Medication was ordered, stored and disposed of appropriately. Staff completed medication administration records (MAR charts) following the administration of medicines.” from the report
Kind staff
Inspectors found that staff treated people with respect and understood their communication. Relatives and professionals also gave positive feedback about staff.
“People were supported by a kind and caring staff team who treated them with respect.” from the report
Involvement
People took part in residents' meetings about matters such as activities and menus. Picture cards helped make these meetings accessible.
“There were regular residents' meetings at the service where matters, such as activities and menus, were discussed.” from the report
Limited community access
seriousPeople often could not go out as frequently as they wanted because two staff were needed and staffing vacancies meant this support was unavailable. One person went without community support for four months.
“Last year, one person had not been supported by staff to go out into the community for a period of four months before they started to be supported to go out again.” from the report
Staffing shortages
needs fixingThere were many vacancies and agency staff were used to fill gaps. On some occasions there were not enough staff on duty to meet people's needs.
“There were a large number of vacancies at the service and agency staff were used to fill gaps in the rota.” from the report
Unstructured activities
needs fixingSome people had little planned to do during their support time and appeared bored. Support plans did not always identify meaningful goals and outcomes.
“We observed that there was a lack of structure to the support some people received.” from the report
Communication style
needs fixingStaff sometimes told people what to do instead of making suggestions or asking what they wanted. New communication training was planned.
“We heard staff telling people what to do on a number of occasions rather than making suggestions or asking people what they would like to do.” from the report
PPE practice
minorStaff were not always using personal protective equipment in line with current guidance during personal care. The manager addressed this immediately.
“We saw that staff were not always using PPE in line with current guidance when providing personal care.” from the report
- 01How many staff vacancies are there now, and how will you ensure there are always two suitably trained staff available for community outings?
- 02How are you making sure each person's funded support hours are delivered and used for activities that matter to them?
- 03What training have agency staff received before supporting people in the community?
- 04How are you checking that staff offer choices and use each person's preferred communication method?
- 05What progress has been made on the action plan requested by CQC, and when will families be updated?
This was a focused inspection of Safe, Responsive and Well-led only; Effective and Caring were not inspected and their previous ratings were used to calculate the overall rating. This explanation was written from the published report of 21 June 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, September 2019
Rated Good; inspectors found safe, kind and personalised care, with some improvements still needed in communication, pain assessment and audit records.
This was the home’s first inspection since it registered. The visit took place on 12 and 13 August 2019. It was announced 48 hours in advance because people had complex needs. One inspector observed care, reviewed records and sought feedback from four families.
The home was caring for six younger adults with learning disabilities and/or autism. Inspectors found enough staff, respectful care, safe medicines management and personalised support. People were helped to make choices, stay in contact with family and access the community.
Inspectors also found some areas that needed strengthening. There was not yet a consistent written way for all staff to recognise pain when people could not communicate verbally. Some completed audits did not clearly show that identified actions had been completed. Families gave mixed feedback about activities and communication.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. This means inspectors found the service was meeting the relevant standards at the time of this inspection, but Good does not mean that every part of the service was perfect.
Respectful care
Inspectors observed caring interactions. Staff knew people well and supported their dignity, privacy and individual needs.
“We observed respectful and caring interactions between staff and people.” from the report
Enough skilled staff
Staffing levels were matched to people’s assessed needs. New and temporary staff received induction and support before working independently.
“There were enough staff to meet people's needs.” from the report
Personalised support
People received tailored care based on their routines, communication methods, interests and preferences. They were supported to make everyday choices and access the community.
“There was a strong person-centred culture at the service and people received individualised, tailored care.” from the report
Safe medicines
Staff who gave medicines were trained and checked as competent. Medicines were stored, ordered and recorded safely.
“People had their medicines given as prescribed and records were clear and accurate.” from the report
Positive approach to improvement
The provider and manager responded positively to the inspection and started work on improvements when inspectors raised issues.
“Any feedback was immediately picked up and work started to further improve the service.” from the report
Pain assessment
needs fixingPeople could not communicate verbally, and there was no consistent written tool or guidance for all staff to identify when pain relief might be needed. The home began looking at how to improve this.
“There was no means, such as a pain scale or details available for all staff to ensure the response was consistent.” from the report
Audit follow-up
needs fixingSome audits identified issues but did not clearly record what action had been taken. The home started work to make this evidence clearer.
“Not all audits that had been completed showed actions had been taken to address issues identified.” from the report
Mixed family feedback
minorRelatives gave mixed feedback about communication, the development of the home and the quality and consistency of activities. These concerns were shared with the manager.
“We received a mixed response from relatives that included extremely positive feedback and some concerns.” from the report
- 01What pain assessment tool or written guidance is now used when a person cannot communicate verbally?
- 02How do you check that actions from audits have been completed and recorded?
- 03How will you keep families informed about changes in care and the development of the home?
- 04How are activities planned around each person’s interests, and how do you check that activities are provided consistently?
- 05How are restrictive interventions monitored to make sure they remain a last resort and are used in a person-centred way?
This was the first planned comprehensive inspection of the newly registered care home, covering all five CQC questions. This explanation was written from the published report of 19 September 2019 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 Keyll House
2 rated inspections over 3 years: the service has slipped, from Good to Requires improvement.
- June 2022Requires improvementcurrent ratingdown from GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2019GoodSafe: GoodResponsive: GoodWell-led: Good
- September 2018
Registered with the Care Quality Commission on 13 September 2018.
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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