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Inspection carried out on 7 February 2018

During a routine inspection

An unannounced comprehensive inspection took place of Kingsley Nursing Home 7 & 8 February 2018.

We carried out an unannounced comprehensive inspection of this service in January 2017 when a breach of legal requirement was found. We found a breach in regulation regarding the service not having suitable systems and processes in place to ensure the environment and equipment was safe and used safely. We undertook a focused inspection on 12 April 2017 to check that they had they now met legal requirements. On the inspection of 12 April 2017 we found improvements had been made and the service was now meeting requirements. While improvements had been made around monitoring the home's environment we had not revised the rating for this key question. To improve the rating too 'Good' would require a long term track record of consistent good practice. We reviewed our rating for ‘well led' at this inspection and the rating was changed to ‘Good’. The overall rating for this service is now ‘Good’.

Kingsley Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Kingsley Nursing Home is a care home in the Birkdale area of Southport. The service offers accommodation, support and nursing care for up to 25 older people. The nursing home is accommodated across two Victorian houses that are connected through an internal corridor. Car parking is available at the front of the building and there is a garden to the rear of the building.

There was a registered manager in post at the time of our inspection. 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.

People told us they felt safe living at the care home and that they received a good standard of care from a kind, approachable and caring staff team.

Staff were aware of what constituted abuse and how to respond to an actual or alleged incident. Policies and procedures were in place to protect people from abuse.

Staff we spoke with were able to describe how they protected people’s dignity and right to choose how they wanted their care delivered. Our observations showed staff provided care in accordance with assessment need. Staff were considerate and polite when supporting people.

Ways in which people communicated were recorded to help make their needs known. With regards to the people we discussed, staff had a good knowledge of how people communicated their needs and how they wished to be supported.

At the time of our inspection there were sufficient numbers of skilled and experienced staff to support people. The provider has agreed to provide extra care hours each day for staff to support people with social activities. The activities organiser had left recently and the provider had advertised this position.

Staff recruitment procedures were robust to ensure staff could work with vulnerable people.

We found the home was operating in accordance with the principles of the Mental Capacity Act 2005 [MCA]. Staff sought consent from people before providing support.

The registered manager had made appropriate referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards [DoLS]. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Risks to people’s health, safety and welfare were assessed and measures were put in place to reduce risk, whilst being mindful of people’s rights to i

Inspection carried out on 12 April 2017

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service in January 2017 when a breach of legal requirement was found. We found a breach in regulation regarding the service not having suitable systems and processes in place to ensure the environment and equipment was safe and used safely.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 12 April 2017 to check that they had they now met legal requirements. On this inspection we found improvements had been made and the service was now meeting requirements.

This report only covers our findings in relation to the specific area / breach of regulation. This covered one question we normally asked of services; whether they are 'safe'. We made a recommendation under ‘well led’ and reviewed this domain around the future development of auditing system for monitoring standards in the environment and for equipment. We therefore reviewed this domain in respect of this recommendation.

The question 'was the service effective’, ‘was the service responsive' and ‘was the service caring' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kingsley Nursing Home on our website at www.cqc.org.uk.

There was a registered manager in post at the time of our inspection. 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 previous inspection we found a number of safety issues at the home and lack of maintenance in some areas. We saw a number of radiator covers were not securely attached and two radiators were not working correctly in people's rooms. We found in general there was poor maintenance and a lack of safety checks for the windows, for example, cracked and blown glass and some window restrictors were not working effectively.

At this inspection we viewed a number of documents in respect of safety checks on the environment and equipment. We found this breach had been met.

We reviewed the audits (checks) on the environment and equipment to ensure they were being effectively monitored. We found monitoring arrangements in respect of health and safety checks had improved. The provider was aware of the need to monitor closely standards within the environment and equipment and has appointed a member of staff to lead on health and safety following this inspection.

Inspection carried out on 10 January 2017

During a routine inspection

This unannounced inspection of Kingsley Nursing Home Limited took place on 10 & 11 January 2017.

The Kingsley Nursing Home is a care home in the Birkdale area of Southport. The service offers accommodation, support and nursing care for up to 25 older people. The nursing home is accommodated across two Victorian houses that are connected through an internal corridor. Car parking is available at the front of the building and there is a garden to the rear of the building.

A registered manager was 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.

There were processes in place to monitor and review the safety and maintenance of the premises. We however identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 12 of the Health and Social Care Act 2014. This was because the provider did not always have suitable systems and processes in place to ensure the environment and equipment was safe and used safely.

Quality assurance processes and systems were in place to monitor standards and to support future improvement in the home. Areas such as care medicines, staff performance and cleanliness of the premises were well monitored. The current auditing system and health and safety checks for the environment and equipment had however not identified the shortfalls we found during the inspection. For example, general maintenance and safety checks of windows and the heating, also radiator covers not secure.

The provider and registered manager took prompt action to address these areas during and following the inspection.

We recommend further development of the current auditing system for the environment and equipment to monitor standards and ensure the safety of people living at the home.

People living at the home told us they felt staff delivered safe care.

The staff in the home knew the people they were supporting and the care they needed. Staff approach was kind and supportive and people’s individual needs and preferences were respected by staff.

There were enough staff on duty to help ensure people’s care needs were met. The registered manager was however aware of the need to review people’s dependencies on a regular basis and changes were being made to the morning routine to provide more time with people.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults.

Staff were being provided with training and received the support they needed to undertake their job role safely and effectively.

Care plans provided information to inform staff about people's care needs and risks to people’s health and wellbeing had been assessed to ensure their safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. An adult safeguarding policy and the local authority’s safeguarding procedure was available for staff to refer to.

Staff we spoke with told us they always asked for people's consent before providing care and we observed this during the visit.

The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the local authority.

People at the home were supported by the staff and external health care professionals to maintain their health and wellbeing.

An activities organiser was introducing a varied programme of social events and activities in accordance with people’s needs and wishes. This had been well received by people living in the home.

People told us they enjoyed the meals and were able to choose what they would l

Inspection carried out on 20 August 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 25th February 2015, at which a breach of legal requirements was found. This was because medication practices were not as robust as required and improvements were needed to the way in which medication practices were audited.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 20th August 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Kingsley Nursing Home’ on our website at www.cqc.org.uk’

Kingsley Nursing Home is registered to provide accommodation and personal care for up to 25 older people. The nursing home is accommodated across two Victorian houses that are connected by an internal corridor.

A registered manager was 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 focused inspection on the 20th August 2015, we found that the provider had followed their plan which they had told us would be completed by the 31st July 2015 and legal requirements had been met.

Inspection carried out on To Be Confirmed

During a routine inspection

This unannounced inspection of Kingsley Nursing Home took place on 25 February 2015.

Kingsley Nursing Home is registered to provide accommodation and personal care for up to 25 older people. The nursing home is accommodated across two Victorian houses that are connected by an internal corridor. Car parking is available at the front of the building and there is a garden to the rear of the building.

A registered manager was 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.

During the inspection we spoke with seven people who lived at the home. We also spoke with a number of visiting relatives. We spoke with three members of the staff team and with the registered manager and the provider.

We found that people who used the service were protected from avoidable harm and potential abuse because the provider had taken steps to minimise the risk of abuse. Procedures for preventing abuse and for responding to allegations of abuse were in place. Staff told us they were confident about recognising and reporting suspected abuse and the manager was aware of their responsibilities to report abuse to relevant agencies.

Each of the people who lived at the home had a plan of care. These provided a sufficient level of information and guidance on how to meet people’s needs. Risks to people’s safety and welfare had been assessed and guidance on how to manage identified risks was included in people’s care plans. Care plans also included information about people’s preferences and choices about how they wanted their care to be provided.

Staff worked alongside local health and social care professionals to make sure people received the care and support they needed. We spoke with a visiting health care professional who worked into the home and they gave us very positive feedback about the service.

Medicines were administered by registered nurses. We found that medicines were stored safely and adequate stocks were maintained. However, we found a number of areas of medicines management which required improvement. Regular medicines audits were being carried but these were not sufficiently detailed to ensure all areas of medicines management were being checked. You can see what action we told the provider to take at the end of this report.

The manager had knowledge of the Mental Capacity Act (2005) and their roles and responsibilities linked to this and they were able to tell us what action they would take if they felt a decision needed to be made in a person’s best interests.

During the course of our visit we saw that staff were caring towards people and they treated people with warmth and respect. People we spoke with gave us good feedback about the staff team. People described staff as ‘very kind’ and ‘lovely’.

People who lived at the home told us there were sufficient numbers of staff on duty to meet their needs. Some people commented that it would be nice if there were extra staff and this was echoed during our discussions with members of the staff team.

Staff told us they felt supported in their work. They told us they had the training and experience they needed to carry out their roles and responsibilities. The majority of staff held a relevant qualification and many of the staff had worked in the home for a number of years.

The premises were safe and well maintained and procedures were in place to protect people from hazards and to respond to emergencies. The home was fully accessible and aids and adaptations were in place in to meet people’s needs and promote their independence. However, we found some limitations with the environment and the facilities provided. We have made a recommendation for the provider to re-evaluate the communal space and how it is utilised.

The home was clean and people were protected from the risk of cross infection because staff followed good practice guidelines for the control of infection.

Systems were in place to check on the quality of the service and ensure improvements were made. These included surveying people about the quality of the service and carrying out regular audits on areas of practice.

Inspection carried out on 4 December 2013

During a routine inspection

We spoke to people about this service and spent time observing people to gain a balanced overview of what people experienced and how they were cared for. We spoke to three people using the service, one relative and three staff members.

We saw that staff knew the people using the service. They had read service users’ care plans, which were signed by them or their relatives and interacted with people and their relatives cheerfully.

A relative said that the staff were, “all excellent and very caring.”

We looked at staffing rotas for different days of the week at random dates for the last three months to see that staff numbers were consistent and we reviewed the training records for all staff and saw that they had received training appropriate for the service provided.

We talked to staff about, and saw records of comments and suggestions made by people and their relatives and saw how they were responded to. There had been no written complaints made in the last four years.

We looked at the safety and suitability of the premises and saw current safety assessments and certificates.

Inspection carried out on 10 January 2013

During a routine inspection

We spent time with four people who were living in the home. Two people were able to tell us about their views and experiences of the Kingsley Nursing Home. People told us they were satisfied with the care and support provided to them. One person said, “I am really happy here. The staff are great. One of the care assistants regularly goes out with me to the village or to the cinema.” Another person said “It is a very good place. Everybody is so kind.”

We spoke with three people who were visiting friends or relatives who live in the home. All were pleased with the care and support being provided. One of the relatives we spoke with said “The care here is superb. The staff really know how to look after people” and “We are always made to feel welcome when we visit.” Another relative said, “We have been most impressed with the home. It is like a family. They treat everyone with love, respect and care.”

All the people we spoke with said they or their relatives were always treated with dignity and respect. We were told the food was of a good quality and there was always a choice available. One person said “The food is lovely.” We found there was an extensive programme of activities being delivered in the home by an activities coordinator who worked four afternoons a week. People and their relatives valued this service, which included both group activities and individualised sessions in people’s rooms.

Inspection carried out on 22 September 2011

During an inspection to make sure that the improvements required had been made

People told us that their medicines were usually given at about the same times every day. One person we spoke with told us that they usually had their morning medicines at about 10am. Another person told us that carers applied their creams when they needed them.

Inspection carried out on 15 July 2011

During an inspection to make sure that the improvements required had been made

People we spoke with told us that medicines were given at about the same times every day. One person added ‘I know what I have and I think they do them accurately’; a second person confirmed that they had enough information about their medicines, and any changes to them.

Inspection carried out on 25 May 2011

During a routine inspection

On the day of the site visit five people who lived in the home were interviewed. We asked them about their experiences of how the service involved them and kept them informed. We were also able to make general observations of people's wellbeing as further evidence of inclusion.

The people living at the Kingsley told us that staff supported them to make their own decisions and they confirmed they were involved in the planning of their care and that staff discussed the options with them. This included receiving care and support in accordance with their wishes and needs. Their comments included, “The staff come and help me” and “They are very attentive”. People also said the staff responded flexibly to meet their different choices. For example if people choose a particular diet this is catered for.

People told us that if they needed advice or support from other health professionals this was quickly obtained for them. A health care professional was contacted and stated that the staff were prompt in seeking advice and that staff ensured the necessary care and treatment was actioned following their visit

People we spoke with said that meals provided were good and they were offered plenty of choice. Several of the people living at the Kingsley needed support to eat their meals. We observed staff providing this support in an unrushed and respectful manner. We observed a meal time and the pace of the meal was appropriate and appeared to be a sociable occasion.

People appeared relaxed and said they felt ‘comfortable’ with the staff. They said staff had time to socialise with them and they were confident that any concerns they had would be listened to and addressed.

People told us they get their medicines on time and that they could choose to look after their own medicines with staff support.

Discussion with people at the home confirmed they were pleased with the standard of cleanliness and that good standards of hygiene were consistent. This included the bathrooms, shared toilets and bedrooms. People did not raise any concerns in respect of the standard of furnishings in their private rooms and they said there was sufficient equipment to help them maintain their independence.

We received positive comments about the staff and they were described as caring and kind. People told us the staff worked well as a team and they had confidence in the staff’s ability to care for them.

Reports under our old system of regulation (including those from before CQC was created)