Kingsleigh

Kingsleigh is owned and operated by Care UK Community Partnerships Ltd. It provides accommodation and personal care for up to 67 older people, who may also be living with dementia. The facilities are purpose built and organised into five, ground floor units with level access from the car park. On the day of our inspection 44 people were living at the service.

The provider had implemented measures to reduce the risk of infection. Staff were observed wearing appropriate Personal Protective Equipment (PPE) and they received ongoing training in its correct use.

The service was clean and hygienic. Additional cleaning schedules had been implemented since the beginning of the pandemic, including the continuous cleaning of high-touch areas such as door handles and switches. Deep cleaning of communal areas, including the use of an antiviral fogging machine was carried out overnight.

The provider had an infection prevention and control (IPC) policy. Designated staff carried out regular IPC audits to ensure appropriate standards in this area were maintained.

The provider had taken action to minimise risks to people who used the service and staff. Risk assessments had been carried out to identify and mitigate risks, including for people in vulnerable groups.

Staff accessed weekly Covid testing. If staff returned positive test results or had Covid symptoms, they did not return to work until they had completed the required period of self-isolation.

People who lived at Kingsleigh also had access to regular testing and valid consent had been obtained in respect of this. Where people lacked the capacity to consent to testing, the registered manager had ensured decisions were made following best interests principles.

If people displayed symptoms or tested positive for Covid, staff encouraged them to self-isolate in their bedrooms. Where this was not possible, people were supported to remain on their own units to minimise the risk of spread across the service.

People’s families were unable to visit inside the home at the time of this inspection due to its outbreak status. Exceptions were however made for people receiving end of life care. Staff supported other people to maintain contact with their families through phone calls and video meetings. Prior to the outbreak, relatives had been able to book appointments to visit their loved ones either in the garden or a designated Covid-secure visiting room. All visitors to the home were required to wear appropriate PPE and screened before entering the service, including temperature checks and a Covid questionnaire.

Staff supported people to access the healthcare treatment they required. The registered manager had good links with the local District Nursing service who were providing daily support where needed.

Staff had been well supported during the pandemic through the provision of information and guidance, at team meetings and at individual meetings. Staff had been encouraged to speak up about any anxieties or concerns they had.

We found the following examples of good practice:

The home’s staffing model ensured people received consistent support and minimised the risk of cross-infection across the service. As far as possible, staff were assigned to work in only one area of the service. Core staff had worked additional hours and been flexible with their shifts to mitigate the need for agency staff to work within the service.

Further information is in the findings below.

Kingsleigh 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.

Kingsleigh is owned and operated by Care UK Community Partnerships Ltd. It provides accommodation and personal care for up to 67 older people, who may also be living with dementia. The facilities are purpose built and organised into five, ground floor units with level access from the car park. On the day of our inspection 50 people were living at the service.

The manager for the service had been in post since November 2017 and is currently in the process of applying for registration. 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 last carried out a comprehensive inspection of this service on 10 October 2017 when we rated the service as Inadequate in the well-led domain and Requires Improvement overall. At that inspection we highlighted significant concerns about the leadership of the service. The management team had failed to respond to concerns that staffing levels were not sufficient and that people’s needs were not being met. Complaints made by relatives had not been listened to and acted on and people were not receiving a personalised service. Following that inspection, we issued a Warning Notice against the provider that required them to take swift action to improve their monitoring and governance of the service. We also made four requirements to ensure the service maintained safe staff levels and effectively trained staff, improved the way complaints were managed and delivered safe and personalised care. This inspection found that these actions had now been complied with.

After the last inspection, the provider submitted a detailed plan of improvement and appointed a new management team. The manager and the provider have been in continuous contact with CQC to provide updates on the progress being made. They also supplied weekly rotas to us so we could be assured that appropriate staffing levels were being maintained.

At this inspection, we found the provider had taken the action they told us they had and the service was now providing a good level of care to the people living at Kingsleigh. The new management team had been successful in turning the service around and the culture at Kingsleigh had become, open, inclusive and vibrant.

Systems for monitoring quality were now effective and used to continually drive improvement. People and their representatives were involved with and consulted about the direction of the service and their feedback was listened to and valued.

Staffing levels were now sufficient to deliver safe and personalised care. People received support from a team of consistent team of staff who had been appropriately recruited and trained to meet their needs.

Staff understood their roles and responsibilities in keeping people safe and the systems in place to safeguard people were used properly to protect people from harm. Risks were now identified and managed in a way that balanced people’s safety and independence.

The atmosphere in the service was relaxed and friendly and people had good relationships with the staff who supported them. Staff knew and respected people’s needs and choices and people were now at the heart of planning their own care. Care was provided with compassion and staff respected people’s privacy and dignity.

People’s needs and choices had been better assessed to ensure support was delivered in a way that respected their legal rights. People experienced a much more person-centred approach to care and staff were responsive to people’s changing needs. Staff were creative in the way they engaged with people and people had opportunities to participate in meaningful and enjoyable activities.

Staff worked collaboratively and in partnership with other healthcare professionals to ensure people received holistic personal and health support. Medicines were managed safely and staff took steps to ensure people received their medicines as prescribed.

People were supported to maintain adequate levels of nutrition and hydration and mealtimes were a sociable occasion that brought people together. Specialist diets and preferences were catered for.

The service was clean and improvements to the management of continence and infection control had significantly improved. An ongoing programme of refurbishment and redecoration was underway to enable the environment at Kingsleigh to effectively support people living with dementia.

This inspection was carried out over two dates, both of which were unannounced. The first inspection was undertaken in the early hours of 28 September 2017. We then returned to the service on 10 October 2017.

The home 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.

We last carried out a comprehensive inspection of this service on 3 November 2016 when we rated the service as Good.

This inspection was brought forward in response to concerns we had received about the care being provided at Kingsleigh. Due to the nature of the concerns that were raised, we inspected the service in the early hours of the morning. Following the first inspection date, we made contact with the provider to discuss our findings, in particular the concerns we had about staffing levels at night. As a result of the issues we shared with them, the provider sent us an initial action plan which outlined the immediate steps taken to improve the safety of the service. The second inspection visit was to assess the impact of the action plan and to review the overall rating of the service.

The findings from this inspection highlighted significant concerns about the leadership of the service. The management team had failed to respond to concerns repeatedly highlighted by staff that staffing levels were not sufficient and that people’s needs were not being met. Internal auditing and monitoring had further failed to identify that the service was not providing good outcomes to people. Complaints made by relatives had not been listened to and acted on. As a result of our findings we found five 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 the report.

Until very recently, staffing levels at Kingsleigh were so insufficient that the service was not safe. In response to the concerns raised, the provider allocated a management support team to the service and took immediate steps to increase the number of staff on duty. Staffing levels were raised and agency staff were brought in whilst permanent staff were being recruited. On our second inspection day, staff reported that staffing levels had significantly improved and that consequently they now felt able to support people safely. Due to the current reliance on agency staff, the provider is sending us weekly rotas to demonstrate that safe levels continue to be maintained.

Risks to people were not always managed safely. The management team had failed to appropriately respond to incidents that were occurring and consequently a service was being offered to some people whose needs were unable to be met. Staff were not sufficiently trained or supported to manage these people’s specialist needs. The escalating behaviours of some people and the poor management of this placed people at risk of harm. Following our inspection, urgent steps were taken to find more suitable placements for some of the people who were living at Kingsleigh.

The environment was not used effectively to support people living with dementia. There were little points of reference to orientate and engage people in their surroundings and consequently this further increased people’s anxiety and behaviours. Bedrooms were not easily identifiable and people spend time in rooms that did not belong to them.

The management support team had recognised that care had been provided in a task based way and had taken immediate and effective steps to enable staff to deliver a more personalised approach to care. Care plans were being updated and reviewed to ensure they accurately reflected the support people required. Group activities were enjoyed by those who participated. Opportunities were however missed to deliver meaningful activities and engagement to people on a one to one basis throughout the day.

The management support team were working closely with other professionals to ensure people’s health care needs were being met. Staff understanding of the Mental Capacity Act was varied and assessments of people’s capacity were not always completed in a person-centred way. Staff did however understand the principle of providing support to people in the least restrictive way.

Staff had a good understanding of their personal roles and responsibilities in safeguarding people from abuse. Staff advocated strongly on behalf of people and took steps to ensure any concerns about abuse were reported and dealt with quickly. Appropriate recruitment checks were carried out to ensure suitable new staff were employed. Staff received regular supervision and appraisal, but these were not always effective in furthering their professional development.

Medicines were managed safely and people received their medicines as prescribed. Our first inspection highlighted that some people did not have appropriate guidelines in place to support the administration of occasional medicines, such as pain relief. By our second inspection date, many of these guidelines had been implemented and team leaders had a good knowledge of people, so they received their medicines when needed.

People had choice over their meals and appropriate action had begun to ensure people were effectively supported to maintain a healthy and balanced diet. A staff member had recently been appointed as a designated champion for nutrition. This meant that they were starting to have a better oversight of people’s weights and nutrition risks. Food and fluid charts were being used to monitor those people identified as being at high risk of malnutrition or dehydration.

Staff remained caring and compassionate towards people, despite working in very difficult conditions themselves. Staff had a good knowledge of people’s lives and used this information to support people with empathy and understanding. End of life care was provided with dignity and humility with staff supporting people to live their last days peacefully and in the presence of their loved ones.

The provider was open and transparent about the shortfalls within the service and committed to taking swift action to improve the service. Staff felt motivated and well supported by the management support team and they were all working together to move the service forwards.

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.

The last inspection of Kingsleigh took place in December 2013. The service met all the regulations we checked at that time.

People were happy with the care they received at the service. Staff understood the types of abuse and their responsibility to report any concerns to protect people from harm. People received safe and effective care and support. People’s medicines were securely stored and administered safely.

Staff treated people with kindness and respect. People had sufficient healthy meals which they liked. Staff supported people to eat and drink and followed healthcare professional’s advice to support people with their nutritional needs as required. There were sufficient staff on duty to meet people’s needs. The provider used safe and robust recruitment practices.

The registered manager assessed risks to people’s health and safety. Staff had sufficient information and guidance to manage the known risks. People received support to pursue their hobbies and interests.

Staff had the experience and skills to support people effectively. Staff received appropriate training and the necessary support through supervision to enhance their work. Staff felt confident the registered manager valued their ideas to improve the service.

People and their relatives were involved in the planning of people’s care. Staff asked people for their consent before providing them with care and support. Staff knew people well, understood their needs and respected their views on how they wanted to be supported. Staff respected people’s privacy and dignity.

The registered manager carried out regular audits on management of the service and asked people and their relatives about the quality of care people received. The registered manager used their ideas and feedback to drive improvement.

The registered manager recorded and monitored incidents and accidents and ensured staff took appropriate action to minimise recurrence. The registered manager had looked at complaints and addressed them in line with the service’s procedures.

People had access to healthcare services when needed. The registered manager worked in partnership with other healthcare professionals to ensure people received the support they required.

We found that people who used the service were always being asked by staff if they consented to their care, and their right to refuse care was being respected. The people we spoke with said that care was never forced upon them. We also found the provider had a process in place to deal with situations where decisions had to be taken in a person's best interest.

We found that people were happy with their care and that staff engaged with people in an appropriate and sensitive manner. One person said they had been in the home for two years and said they loved it. 'I can't think of one wrong thing to say about the place." We also found that people's needs were being properly assessed, managed and reviewed.

We found that people were being properly protected against abuse and staff were able to identify, respond to, and report abuse in an appropriate manner. All the people we spoke with said they felt safe from harm in the home.

We found that staff were being properly supported and received regular training, supervision and appraisal. Staff told us they thought they had opportunities to progress within the organisation.

We found that the provider was regularly obtaining feedback from people who used the service and staff. We also found that the provider monitored and assessed the whole service on a regular basis.

We found that suitable arrangements were in place to ensure the dignity, privacy and independence of people using the service. Although people were unsure about the level of their involvement, we saw clear evidence that people had expressed their views and were involved in making decisions about their care and support.

Regarding the standards of care provided, one person told us, 'I'm well looked after, everybody is lovely'. We observed that this was reflected in the culture and atmosphere within the service.

As a result of the policies we found in place and the training received by staff, we found that there were arrangements in place to deal with foreseeable emergencies

We also found that there were effective systems in place to reduce the risk and spread of infection. One person told us, 'I think the hygiene standards are high and that's good'.

A relative that we spoke with told us, 'I think the staffing levels are very good. Most staff tend to stay a long time if that's any guide'. Another told us, 'The staff attitude toward residents is so very good'.

We carried out a review of all the notifications required to be forwarded to the CQC from Kingsleigh during 2012 and found the records to be comprehensive and complete.