Archived: Kingfield Holt

This inspection took place on 21 January 2019 and was unannounced. This meant the staff and provider did not know we would be visiting.

Kingfield Holt 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.

Kingfield Holt is registered to provide accommodation and personal care for up to 23 people. Accommodation is provided over two floors, accessed by stairs or a passenger lift. Communal lounges and dining areas are provided. The home is a detached period building with a large garden close to local amenities. The care provided is for people who have needs associated with those of older people. On the day of our inspection there were 15 people living at the home.

Our last inspection at Kingfield Holt took place on 25 and 26 January 2018. We found the service was in breach of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. Regulation 11, Need for consent, Regulation 12, Safe care and treatment, and Regulation 17, Good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the Regulations.

There was an acting manager at the service. The previous registered manager had very recently retired from the service. 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 and associated Regulations about how the service is run.

People living at Kingfield Holt told us they felt safe and they liked the staff. Staff confirmed they had been provided with safeguarding vulnerable adults training, so they understood their responsibilities to protect people from harm.

Regular checks of the building were carried out to keep people safe and the service well maintained.

There were sufficient numbers of staff available to keep people safe. The staff recruitment procedures and checks in operation promoted people’s safety.

We found systems were in place to make sure people received their medicines safely.

Staff were provided with relevant training and supervision to make sure they had the right skills and knowledge to support people.

Staff gave people as much choice and control as possible.

People enjoyed the food provided and were supported by staff to receive adequate food and drink to remain healthy.

We found the home was clean, bright and well maintained.

People had access to a range of health care professionals to help maintain their health.

People were treated with dignity and respect and their privacy was protected. People and health professionals we spoke with made positive comments about the care provided by staff.

A range of activities were available to provide people with leisure opportunities.

People were confident in reporting concerns to the acting manager or staff and felt they would be listened to and their concerns would be addressed.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Staff told us they felt they had a very good team. Staff and people said the acting manager was approachable and communication had improved within the service.

Kingfield Holt 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.

Kingfield Holt is registered to provide accommodation and personal care for up to 23 people. Accommodation is provided over two floors, accessed by stairs or a passenger lift. Communal lounges and dining areas are provided. The home is a detached period building with a large garden close to local amenities. The care provided is for people who have needs associated with those of older people. On the days of our inspection there were 16 people living at the home.

The service 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.

At the last Inspection in December 2015 we rated the service ‘Good’. During this inspection, we found that the service had not sustained the previous Good rating. The overall rating was now Requires Improvement. The key questions Safe, Effective, Responsive and Well-led were rated Requires Improvement. We found breaches of Regulation 12: Safe care and treatment, Regulation 11: Need for consent, 17: Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements were required in the systems for the safe management of medicines. We inspected the registered provider's ‘Medications Management Policy and Procedure’ document and found this was in need of further review. Individual risk assessments were not completed to find out how much support a person needed with managing and taking their medicines. People did not have PRN protocols in place.

We have made a recommendation that the service consider the National Institute for Health and Clinical Excellence (NICE) best practice guidelines on good practice for managing medicines in care homes.

Risk assessments looked at the associated risk in carrying out an activity however, they did not contain measures to reduce the potential risks. Risk assessments contained 'scores' for each aspect of the person's pressure care. However, there was nothing to indicate the significance of each score, how the information was calculated and how the risk was mitigated.

We recommend that a risk assessment is completed which describes what measures are in place to control the risk and consider any additional measures that could be put in place to remove or reduce the likelihood of the risk causing harm to the person or staff member.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 Staff we spoke with understood the principles of the MCA and provided examples of how the MCA would apply to the people they provided support to. However, we found improvements could be made to ensure the person who lacks capacity is at the heart of the decision making process.

We have made a recommendation about further training around assessing people’s capacity and acting in people’s best interest.

Quality assurance systems, which helped the provider and the registered manager to identify shortfalls, were not robust and required improvement.

Staff were provided with training and supervision to make sure they had the right skills and knowledge to support people although there were gaps in training around the safe management of medicines. This meant staff had not been provided with relevant training to update and maintain their skills and knowledge to meet people's needs

The registered provider had a safeguarding procedure to ensure systems were in place to protect people from abuse.

There was an effective recruitment process in place, which meant the provider made safe recruitment decisions.

Systems in place for infection prevention and control were effective. The environment was well maintained and effectively cleaned. Staff told us they had been provided with training in infection control procedures so that people's health and safety was promoted.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people's health was promoted and choices could be respected.

We observed staff interacting with people and found they were kind, caring and compassionate.

Staff we spoke with gave mixed opinions about how the registered provider and registered manager handled their concerns. Some staff did not feel listened to, but others felt their concerns had been dealt with satisfactorily. Staff told us they had never had a staff meeting or been asked about their views or opinions and how they thought the service could improve.

The service had sent out quality assurance surveys to people who used the service and their relatives. However, here was no record of meetings with people using the service to gain their feedback and views on how the service could be improved.

People we spoke with made positive comments about the staff and were satisfied with the quality of care that they had received. Their comments included: 'I have my medication when I need it', 'they (staff) are very good' and 'I don't think you will find a better place'.

People told us that they felt 'safe'. They told us that they did not have any concerns and if they did they would speak to their relative or a staff member.

We spoke with three members of staff. All staff spoken with were clear about what their roles and responsibilities were and the action they would take if they saw or suspected any abuse.

Staff told us that they felt supported and made positive comments of about the senior staff and staff team. One staff member commented: 'any problems I can speak to any member of staff'.

The provider had a system in place to regularly assess and monitor the quality of service that people receive.

We observed staff providing reassurance, care and concern to people. We spoke to six people who told us that they were satisfied with the quality of care provided. Their comments included: 'Very satisfactory, very good.' 'Night staff are very good.' 'The carers are very friendly and polite.' 'I would definitely recommend Kingfield.'

We saw that people in the home benefited from equipment that was comfortable and met their needs.

We found that the unavailability of staff to cover for unexpected absence had resulted in staff working long hours but people did not have any concerns about the quality of care they had received as a result of this.

We found that staff had received training and were supervised. We saw evidence that staff had the opportunity to develop and improve their skills.

We saw that the home had a system in place to deal with comments and complaints. We also saw that the home had provided people with information about this system. All the people we spoke with told us that if they had a concern they would speak to staff. They all felt that their concern would be treated seriously