Archived: Kingsleigh Residential

Kingsleigh Residential is a residential care home providing personal care for up to 23 people. The service provides support to older people. At the time of our inspection there were 17 people using the service.

Kingsleigh Residential is a large detached property. There is a communal lounge and dining area on the ground floor. Bedrooms are on the ground and first floor. There is an enclosed garden at the front.

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

The provider and registered manager had not ensured people received safe or good quality care as there was widespread and significant failings across all aspects of the service. There was a lack of oversight and governance. This put people's safety at risk and meant people did not receive a caring service.

Improvements had been made to the environment and in relation to health and safety. However, previous shortfalls continued not to be addressed and further shortfalls were identified.

The provider and registered manager had failed to follow safe recruitment procedures and ensure staffing met people’s needs. Risk management was not effective to ensure risks to people were identified and reduced. For example, with catheter care, food and fluids and skin integrity. Medicines were not safely managed. People were not safeguarded from potential abuse and neglect and the reoccurrence of accidents and incidents.

Staff did not receive the necessary training or supervision to enable them to be fully skilled and knowledgeable in their roles.

The service was not well-led or managed. Records were poorly maintained. There was a lack of opportunities for people, staff and relatives to engage, feedback and develop the service. The provider had failed to adhere to the conditions on their registration.

Consent to care was not always delivered in line with guidance. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Complaints and concerns were not identified or thoroughly investigated to ensure changes were made.

People enjoyed the food on offer. We observed staff being kind and caring with people. Consistent staff knew people well and their preferences.

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 02 September 2022).

At the last inspection in June 2022 we identified continued breaches of Regulation 12 (Safe Care and Treatment), Regulation 15 (Premises and Equipment) and Regulation 17 (Good Governance). Following the last inspection in June 2022, we imposed a condition on the providers registration in relation to Regulation 12 and 17.

The provider completed an action plan after the last inspection in relation to Regulation 15 to show what they would do and by when to improve. At this inspection we found the provider had made improvements in this area and was no longer in breach of regulation 15.

However, at this inspection we found the provider remained in breach of regulations 12 and 17. Additional breaches of regulation were also identified.

At our last inspection we made 2 recommendations in relation to medicines and the application of the Mental Capacity Act 2005. At this inspection we found the provider had not ensured these recommendations were met.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and due to concerns identified in the management of safeguarding.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsleigh Residential on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to Regulation 7 (Requirements Relating to Registered Managers), Regulation 11 (Need for consent), Regulation 12 (Safe Care and Treatment), Regulation 13 (Safeguarding Service Users from abuse and improper treatment), Regulation 16 (Receiving and acting on complaints), Regulation 17 (Good Governance), Regulation 18 (Staffing), Regulation 19 (Fit and proper persons employed) and Regulation 20 (Duty of Candour).

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will follow our enforcement procedures.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kingsleigh Residential is a residential care home providing personal care for up to 23 people. The service provides support to older people. At the time of our inspection there were 17 people using the service.

Kingsleigh Residential is a large detached property. There is a communal lounge and dining area on the ground floor. Bedrooms are on the ground and first floor.

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

An overall service improvement plan had not been completed. Therefore, whilst some improvements had been made, we identified shortfalls in the oversight of the premises and risks to people. Governance systems were still not full effective in identifying actions required and driving quality and safety improvements.

The provider had not ensured the systems and culture within the service drove high standards of care to ensure people were well treated and supported. People, relatives and staff did not have opportunities to give feedback about the service and be engaged in the development of the service.

Training records had been improved and were now organised. Staff received training and ongoing supervision to be skilled in their role. New staff received an induction.

People were supported by staff who were kind and caring. Staff knew people and their preferences well. Changes in staffing meant there was mixed feedback received about staffing levels and how this impacted on care delivery.

People enjoyed the food provided and enjoyed a social dining experience. People’s health needs were met. The service worked in partnership with other professionals.

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.

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 inadequate (published 06 August 2021) where breaches of Regulation 12, 15 and 17 were identified. A recommendation was made in relation to staff training records. Following the inspection published 06 August 2021, the provider was placed in special measures. After the inspection, published 06 August 2021, two warning notices were issued for regulation 12 and 17. These were followed up in a targeted inspection (published 04 October 2021).

At this inspection we found the provider remained in breach of regulations 12, 15 and 17.

At our last inspection we recommended the provider reviewed current guidance around the recording and organisation of staff training. Improvements had been made and the provider had met this recommendation.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

For the key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsleigh Residential on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 12 (Safe Care and Treatment), 15 (Premises) and 17 (Good Governance).

We have made two recommendations in relation to medicines and capacity assessments.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kingsleigh Residential is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service can support up to 23 people.

Kingsleigh Residential is a large converted house. People live in single rooms with mostly shared bathroom and toilet facilities.

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

The provider had made improvements to the service and had met the warning notice in relation to Regulation 12 (Safe care and treatment).

The service now had improved the systems in place to prevent and control infection. Staff had received training in preventing and controlling infection. The registered manager had a program of refurbishment in place and stained and worn flooring was being replaced.

The provider had met the warning notice in relation to Regulation 17 (Good governance). There were improved systems in place to monitor the quality and effectiveness of the service.

Rating at last inspection and update:

The last rating for this service was inadequate (published 06 August 2021) and there were three breaches of regulation.

We served two warning notices in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). At this inspection we found improvements had been made.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) and Regulation 17 (Good governance) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kingsleigh Residential is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service can support up to 23 people.

Kingsleigh Residential is a large converted house. People live in single rooms with mostly shared bathroom and toilet facilities.

The provider did not have any effective systems in place to monitor the safety and quality of the service. There were no systems in place to check and rectify risks to people. The provider could not be sure that the service was effectively cleaned and the premises were safe and maintenance checks carried out.

The provider had not ensured checks were carried out to water systems to protect people against the risk of legionella. Some areas and furnishings of the home could not be thoroughly cleaned and there were no clear instructions for cleaning staff.

The provider could not be sure that all staff had received suitable training for their role as records were poor; we have made a recommendation about this. However, staff were recruited safely, received supervision and there were sufficient staff to meet people’s care needs.

People living at the service had good relationships with staff and were relaxed in their company. Relatives told us they were confident their loved ones were safe and well-cared for as individuals. Staff were warm, friendly and patient with people. Care plans were of good quality, person-centred and contained clear information about people’s needs and preferences. However, we identified some institutional aspects in respect of the weekly shower rota and referring to people by their room numbers.

Staff morale was good; staff told us they enjoyed working at the home. Staff felt supported by the registered manager who was approachable. Relatives also commented positively on the registered manager.

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.

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 04 September 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the overall safety of the service and the provider’s governance systems and oversight of the quality of the service. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsleigh Residential on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to managing infection control, , the condition of the premises, and monitoring the effective running of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kingsleigh Residential accommodates up to 23 older people. At the time of the inspection, 13 people were living there.

People’s experience of using this service:

People were at risk of cross contamination due to staff not being able to access effective hand washing facilities. Hot water temperatures were not being undertaken to ensure they were within safe parameters and on occasions they were recorded as being above recommended guidelines.

Staff were not receiving supervision, training and an annual appraisal in line with the providers policies. People were not always supported by staff who demonstrated compassion and a positive approach to people. The provider failed to ensure quality assurance systems were in place to identify shortfalls.

Some areas of the home required improving such as ceilings and a broken extractor fan. Staff received training in safe administration of medicines however staff were not always recording the administration of topical medicines such as creams. Staff were not always able to demonstrate a good understanding of the types of abuse or the Equality Act 2010. Care plans were not always current and up to date reflecting people’s current care needs or end of life wishes. Not all people knew how to make a complaint should they need to.

People and staff felt the service was safe and that the food was nice. People were supported to access medical appointments and health professionals when required. People had choice and control and had their views sought. Care plans contained important information such as likes and dislikes and people’s personal information. Activities such as exercises, dancing, themed days, and listening to music were provided to people.

People were supported by staff who had checks undertaken to ensure they were suitable to work with vulnerable adults. Incidents and accidents were recorded, and an overview held so that any trends and themes could be identified.

Rating at last inspection: Good (published December 2016).

Why we inspected: This was a planned inspection based on previous rating. At this inspection we found a deterioration had been made and the overall rating had changed from Good to Requires Improvement.

Follow up: We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will continue to monitor the service through the information we receive. We will visit the service in line with our inspection schedule, or sooner if required.

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

Kingsley Residential Home is registered to provide accommodation for older people who require personal care for a maximum of 23 people. The home is set in well laid out gardens and has easy access to Burnham-on-Sea town centre. Some people living in the home were living with a dementia, so were unable to tell us of their experiences.

There is 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 service was not always safe because staff propped the fire doors into the dining room open. Records of fire drills did not show which staff had taken part. However, staff received quarterly fire training and information was available to guide staff during emergencies. Staff did not have all the information they needed to meet people’s dietary needs.

Some areas of the home needed maintenance work. Some people’s emergency call bells were out of reach and there were no call bells accessible in some areas of the home.

People had mixed experience during lunch because one person waited 15 minutes and another person was given their medicines during lunch. However, relatives told us there were sufficient staff to meet people’s needs. People and relatives told us staff were very kind, considerate and friendly.

Staff did not ensure one person was adequately covered to protect their privacy and dignity when they were hoisted.

People or their representatives were involved in planning their care. Care plans accurately reflected the care people needed.

People’s needs were reviewed regularly, and changes made where necessary.

People were given choices, and staff always sought consent before giving people care and support. Staff encouraged people to be as independent as they could be.

Staff received Gold Standard Framework training, which meant people’s end of life wishes were respected.

People and relatives were given opportunities to feedback their views about the home and the service. Everyone was very happy with the service they received.

Staff told us they were supported. Staff completed regular training to give them the skills they needed to be able to meet people’s needs.

Nine people told us they were happy with their care and felt included in their care plans. One person said "The staff are very nice and do everything they can to make you happy here".

We observed that the nine care plans we saw were centred around each person's individual care needs. We noted that each person's care plan contained detailed risk assessments in relation to their daily living needs.

People told us they enjoyed the meals and snacks provided by the home. We observed that three people required close observation of their nutritional status. We noted that nutritional risk assessments had been undertaken for each person and food charts were documented appropriately.

Staff told us about the policies relating to infection control and cleanliness at the home. We observed that home was clean and well maintained and people were able to access the grounds independently.

We observed throughout the visit that staff interacted well with people living at the home. We noted that people were well known to staff which enabled people to fulfil their potential and live full and happy lives at the home.

We noted there were robust quality monitoring systems in place. We saw evidence of where changes had been implemented following the outcomes of the audit programme at the home.

We observed a person centered approach to the planning and delivery of care and support and a family member told us "how happy their relative was in the home"

People told us that they had good relationships with staff and were able to talk to them if they had any concerns. We spoke to two staff who told us "we really enjoy caring for the people in the home and we are supported and valued by the registered manager".

People made positive comments about the staff and one person told us "nothing is ever too much trouble and they really make you feel at home". People really enjoyed the wide range of activities that were available and told us "you can do what activities you want or have a quiet time in your room; it's always up to you".

People told us they felt involved in the decision making in the home and we observed in the Residents Meeting notes how people's requests about changes to the mealtimes were being put in place.