Kingswood House Nursing Home

Kingswood House Nursing Home is a residential care home providing personal and nursing care for up to 22 younger adults who have mental health needs. There were 19 people living there at the time of the inspection. Most people needed support with mental health needs and some people lived with complex health needs, such as Huntington’s chorea. Some people also received rehabilitation support which prepares them for returning to independent living.

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

Systems and processes to assess, monitor and improve the quality and safety of the service provided were in place. However, there were areas of people’s documentation that needed to be improved to ensure staff had the necessary up to date information to provide consistent, safe care. Incident forms were completed but there was a lack of overview, analysis and follow up to prevent a re-occurrence or to mitigate risk. Notifications of incidents and events had not been reported to CQC as legally required for the service since July 2021.

Improvements were needed to the management of risk to ensure people received safe care and support. Incidents and accidents whilst recorded on an incident form were not reflected in peoples’ care plans. There was no analysis of cause, trends or themes, therefore, opportunities of learning from accidents and incidents had been missed. Staff were not monitoring the overall effectiveness of pain relief medicine or looking at the times as and when needed medicine (PRN) requests were made for trends or themes.

People received support from staff who had been appropriately recruited, and trained to recognise signs of abuse or risk. One person said, “I am safer here than anywhere.” Medicines were being given to people by trained and knowledgeable staff, who had been assessed as competent. There were enough staff to meet people's needs. Safe recruitment practices had been followed before staff started working at the service. The home was clean and hygienic.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People, their relatives and health care professionals had the opportunity to share their views about the service. The provider and manager were committed to continuously improve and had developed structures and plans to develop and consistently drive improvement within the service.

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 4 February 2020)

Why we inspected

The inspection was prompted in part due to concerns received about the management of incidents and potential under reporting. A decision was made for us to inspect and examine those risks. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to management of risk, and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kingswood House Nursing Home is a residential care home providing personal and nursing care for up to 22 younger adults who have mental health needs. There were 20 people living there at the time of the inspection. Most people needed support with mental health needs and some people had complex health needs, such as diabetes.

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

People were positive about the support provided at Kingswood House. People said the registered manager was very good and the staff provided the support they needed. Staff knew people very well; they demonstrated a good understanding of people’s individual needs and assisted them to access healthcare services when needed.

Since the previous inspection improvements had been made regarding infection control and the management of medicines. The cleaning schedules ensures the home is clean and tidy and the risk of infection is reduced as much as possible. The management of medicines had been reviewed and we found people received their medicines when they needed them, by staff who were trained to give them out safely.

There was ongoing quality assurance and monitoring of the services provided by the registered manager and provider. Where areas for improvements were identified action was taken to address these and reviewed on the following audit to ensure the changes had been effective.

Risk assessments identified areas where people may need additional support and management plans were included in the support plans; with guidance for staff to follow to reduce risk as much as possible.

There was an ongoing training plan and staff were encouraged to develop their professional practice. Supervision and support for staff ensured they were aware of their roles and responsibilities and provided the support people needed. People were protected from the risks of harm, abuse or discrimination because staff had completed safeguarding training and knew what actions to take if they identified concerns.

There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the home and nurses were registered with the nursing and midwifery council.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported and empowered to be involved in decisions about the support they received and how the services developed. Feedback was positive form people and staff and reflected that they worked well together as a team to provide appropriate support and care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 4 August 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will review the service in line with our methodology for 'Good' services.

Kingswood House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Kingswood House is registered to provide accommodation for people requiring nursing or personal care and treatment of disease, disorder or injury for up to 22 people and younger adults with mental health support needs. At the time of the inspection there were 22 people living at Kingswood House.

There was a manager in post who was currently in the process of applying to be the registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager was fulfilling the role and responsibilities of the registered manager until they were formally registered.

We last inspected the service in August 2017. At that inspection, we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We issued a warning notice to the provider asking them to take immediate action in respect to the following issues; Risks to people’s health and safety were not adequately assessed and action was not being taken to do all that is reasonably practicable to mitigate risks including; risks from insufficient fire safety and infection control measures at the premises, risks of pressure damage and injury from incorrectly fitted lap belts to people. Systems or processes to assess, monitor and improve the quality and safety of the services provided were not operating effectively.

We also asked the provider to make improvements to address the following issues; People’s care and treatment was not always being provided with their consent and the provider was not always acting in accordance with the Mental Capacity Act (MCA) 2005. Premises and equipment used by the service was not always clean, suitable for their purpose and properly maintained.

At this inspection we checked to see if the provider had taken actions to address these issues.

The provider had implemented control measures to reduce the risk of infection. However, issues with the staffing arrangements and people’s behaviour were impacting on the effectiveness of the measures at the time of this inspection and this required improvement. The manager was aware of the issues and was acting to address this.

Systems and processes were operating effectively in assessing and monitoring quality and safety of the service. Where areas of practice required improvement and effective action had not yet been completed, evaluation and learning based on current performance was taking place to drive on-going improvement and avoid future delays.

There was a planned schedule of works in progress and other actions had been implemented to ensure premises and equipment were suitable for purpose and properly maintained.

Risks to people’s health and safety from insufficient fire safety measures, risks of pressure damage and injury from incorrectly fitted lap belts to people had been effectively addressed. People’s support was appropriate and being provided with their consent, in accordance with the principles of the MCA.

Ordering, disposal and storage of medicines was being carried out safely. However, medicine recording systems were not always managed properly and guidance for people’s ‘as and when’ (PRN) medicines lacked detail about when these should be administered.

People told us they felt safe. The service had enough staff and there were safe recruitment practices. Risk assessments were in place that identified any potential hazards to people’s well-being. Risks to people were monitored and staff knew how to support people to safely manage them.

Some risk assessments contained more guidance about how to manage risks safely than others. The manager was aware of this and was in the process of rewriting risks assessments for all people and transferring them onto a new electronic system to make them more accurate and easily accessible for people and staff.

There were systems and processes to keep people safe from abuse. People were protected from discriminatory abuse and supported to know how to recognise abuse and what help they could receive.

The service was effective and helped people to achieve good outcomes. Holistic assessments of people’s needs were carried out to ensure staff knew the support people wanted and needed. People and if necessary other relevant people, such as health and social care professionals were involved in this process.

Any care and support decisions related to any protected characteristics under the Equality Act 2010 were recognised and respected. People were supported effectively with their eating and drinking, medical and health care needs.

Staff worked well internally and externally to deliver effective support and treatment to people. The service shared information and worked with other agencies to co-ordinate people’s support so it remained consistent and effective.

Staff received regular training and supervisions to enable them to deliver effective care. The service kept up to date with best practice guidance and shared this with staff. Rotas were arranged to ensure suitably experienced, trained and skilled staff were always available.

Where appropriate, people had been involved in making decisions about the environment. There were further plans in place to adapt parts of the premises to better meet people’s individual needs and promote their independence.

Staff were caring and involved and treated people with compassion, dignity and respect. People told us they were free and able to make their own choices and could talk to staff about what they wanted to do and how they spent their time.

People were encouraged to be as independent as possible. Staff told us, “I like working at this service compared to others I have been at where it is more institutionalised. They promote independence here”.

The manager told us that the service looked to support people through a rehabilitative model of care. The service always looked to provide people with a programme of support that focused on empowerment and independence. They said, “We are not just here to give people medicine”.

The service was responsive and had recently invested in new resources and systems to ensure that they could sustain and build on providing good quality personalised care. People told us they had been involved with the planning of their care and that their care was discussed and explained to them by staff. This allowed people’s choices to be respected as much as possible.

Staff knew people and the support they needed well. Care plans were in place for people and covered in broad detail information about people’s personal background, relationship information and their support preferences, including their likes and dislikes.

Some care plans contained more detail than others about people’s personal information and how to meet their needs in an individually responsive way. The manager was aware of the was currently revising and transferring people’s paper based care plans to an electronic system to address any gaps in plans.

A dedicated activities team had been recently created and used information about people and the support they wanted and needed to create weekly individual and group activity schedules. These were used to ensure people had responsive support take part in personalised, appropriate and relevant activities.

A recent change in management had been positive and had helped to create a supportive and open team culture. Staff well-being and equality rights were respected. One staff said, “We have a good team and we get on well. I can be open”. Another staff member said they felt they were valued.

The service had a clear vision of enabling people to achieve their preferred outcomes and goals in life through receiving holistic and therapeutic support. Staff received effective support to understand their roles and the values they needed to display to realise this vision.

The service worked well with partnership agencies to help deliver high quality care for people. Staff and people’s involvement in helping to develop the service was encouraged.

Kingwood House provides accommodation over three floors. There were communal sitting rooms and a dining room on the ground floor, and a patio and garden to the rear. The house was situated close to the middle of St Leonards.

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. The provider is Inwood Limited. Kingswood House is the only home Inwood Limited is registered for.

The home has been inspected twice since 2015. At the inspection of 24 and 25 August 2015, the home was rated as inadequate and six breaches in the HSCA 2014 regulations were identified. The home inspected again on 21 and 26 April 2016. At that inspection improvements were identified and it was rated as requires improvement, however a continued breach in Regulation 12 of the HSCA Regulations 2014 in relation to safe care and treatment continued to be identified.

At this inspection, we found the provider and registered manager had not been successful in making all relevant improvements and several areas identified at the inspection of 24 and 25 August 2015 were again identified.

As at the last and previous inspections issues relating to safe care and treatment were identified. This was particularly in relation to the high risk to fire safety. Areas relating to the mitigating of risk to people and cleanliness were also identified, as they had been at the inspection of 24 and 25 August 2015.

At the last inspection improvements were required to ensure the service was well-led. This related particularly to the provider’s systems of quality assurance which had not been effective in identifying matters and ensuring appropriate action was taken. As at the last and previous inspections, the provider continued not to identify all relevant actions, some matters were not documented and some areas did not have action plans to outline how they were to be addressed. This related to a range of areas, including audits of care planning and maintenance of the home environment, as well as safety.

People were not supported by person-centred care plans relating to their daily lives to ensure their individual needs for activity and engagement were assessed, planned with them, and reviewed. This had also been identified at the inspection of 24 and 25 August 2015.

The home environment needed attention to a wide range of areas to ensure it provided a clean, therapeutic and homely place for people to live. This had also been identified at the inspection of 24 and 25 August 2015.

The provider was not ensuring it complied with all relevant areas in accordance with the Mental Capacity Act (2005), to ensure people were supported appropriately in consenting to care and treatment, or if they were not able to do so, such care and treatment was provided in their best interests.

Staff were trained and supported in their roles, however we recommend that the service follow current guidelines in relation to the induction of new staff. Safe staffing levels were maintained and staff were recruited in a safe way.

Some people were not supported in being able to make choices about certain relevant aspects of their care. This was not the case in all areas and in other parts of their care choice was fully supported.

People were safeguarded from risk of abuse by staff who understood their responsibilities. Staff took action to reduce people’s risk in certain areas, such as supporting people in moving safely.

People were supported in taking their medicines in a safe way. Medicines were securely stored and medicines records were maintained.

People had clear care plans about their mental health and medical care needs. Relevant external professionals were contacted where people had additional nursing and care needs. Directives from external professionals were followed.

People spoke favourably about the meals. Where people needed additional support and treatment in relation to eating and drinking, care plans were followed.

People said they liked the staff and were treated with respect by staff who were kindly towards them. They said they could raise issues of concern to themselves and felt they would be listened to. Staff told us the management style of the home was supportive and they could bring forward issues which they felt needed to be addressed.

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

The staff provided nursing and personal care for people with enduring mental health conditions, some of whom had a history of substance or alcohol misuse and a previous criminal background. Some people also had complex physical health conditions and behaviours which may challenge.

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.

At our last inspection on 24 and 25 August 2015 the service was placed in special measures. The purpose of special measures is to ensure that providers found to be providing inadequate care significantly improve. This also provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

At this inspection we found the registered manager, management and nursing team had made improvements to the service. We have judged the service is no longer in special measures. Whilst improvements have been made, there are some areas identified for improvement.

Fire safety measures in place were not sufficiently robust to ensure people would be safely evacuated in the event of a fire.

The quality assurance system in place effectively identified all service shortfalls. However fire safety shortfalls had not been addressed to reduce potential risks to people in the event of a fire.

Staff received regular supervision to discuss their needs. However, supervision records did not consistently and clearly show what action had been taken to address staff development needs to ensure people received effective care. We have made a recommendation about supervision records.

There was an effective maintenance system in place and the provider had made a number of improvements to the building since the last inspection.

Staff had attended training in how to protect people from abuse and harm. Staff were confident in describing how they would recognise potential signs of abuse and what processes they needed to follow to keep people safe. There were safe recruitment procedures in place which included the checking of references.

There was sufficient staff to meet people’s needs. There was a robust management and nursing team in place to support the effective operational and clinical management of the service.

Accidents and incidents were recorded, monitored and analysed to identify how the risks of re-occurrence could be reduced to keep people safe.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The provider had a system for monitoring the cleanliness and maintaining effective infection control standards at the home. We found the home was clean.

Staff had attended training required for their role. Annual appraisals had taken place, to assess and support people’s training and development needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people required a DoLS the registered manager and senior staff team had completed DoLS applications appropriately. They understood when an application should be made and how to submit one.

Staff were able to describe the basic principles of the Mental Capacity Act (2005) (MCA) to ensure they supported people legally in line with their consent. Staff had completed training to understand the requirements of this legislation.

The service provided meals that were in sufficient quantity, well balanced and met people’s needs and choices.

Peoples care plans were consistently and regularly reviewed to reflect any changes in their care and treatment needs. Where the responsibility for people’s care and treatment was shared with health care professionals, reviews of care had taken place with their involvement, to ensure the health, safety and welfare of people.

Staff treated people with kindness and respect. People were satisfied about how their care and treatment was provided.

The provider supported people to meet their diverse care, cultural and spiritual needs. Staff supported people to attend religious services to meet their spiritual needs.

The registered manager sought people’s feedback, comments and suggestions. The provider had analysed the results of any feedback given by people and acted upon this to improve the service.

The registered manager involved people in the planning of activities. There was an activities schedule in place and information on activities available to people.

The provider had explored different ways of giving people information about services available to them in accessible formats and supported people to access these services.

The provider had notified the Care Quality Commission of all significant events that affected people or the service.

Staff were clear on their roles and responsibilities. Staff had a clear understanding of the provider’s philosophy of care to provide people with person-centred, consistent care and ensure people had choice and control over their care and treatment needs.