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Kingston Nursing Home Inadequate

Reports


Inspection carried out on 18 August 2020

During an inspection looking at part of the service

About the service

Kingston Nursing Home is a care home registered to provide personal and nursing care for up to 47 people aged 65 and over, some of whom are living with dementia. During our visit there were 29 people living at the home.

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

People did not always receive safe care. Before and during this inspection we identified and reported safeguarding concerns. People’s medication was not always administered safely and we could not be sure all staff administering prescribed medication were competent to do so. Risks to people’s care were not always managed safely and staff’s knowledge was not robust. During this inspection, we could not be sure people would always be appropriately supported in the event of a fire. The environment was not always clean and free of odours. Staff were not recruited safely.

We identified concerns around staffing levels. People and relatives told us staff were kind but did not have time to be involved in activities. People told us they felt “bored.” This could be a risk to people’s mental health.

We found widespread shortfalls in the way the service was managed. There was a risk of people receiving inappropriate care. Records were not always accurate or complete. Some people's care plans lacked information about people's needs, which meant staff were not provided with clear guidance to support and care for people.

There was no registered manager but an interim manager was in post and a new home manager had recently been recruited. The nominated individual did not always have good oversight of the day to day running of the service.

Quality assurance processes were not effective in identifying and addressing all the issues found at this inspection and in driving improvements.

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 Good (published 4 October 2018).

Why we inspected

Before our inspection we received information of concern in relation to people losing weight and timely action not being taken; risks to people’s care not managed safely including management of medication; and environmental safety risks and governance. Before the inspection, we discussed concerns with the provider and completed an Emergency Support Framework assessment but were not sufficiently assured. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found evidence during this inspection that people could be at risk of harm. We reported these concerns to the provider who took immediate action to make improvements and promote people's safety. We also informed the local authority, clinical commissioning group (CCG) and the local fire authority of our concerns. We found the actions taken by the provider had been effective in mitigating urgent risks, however further improvements were required. Please see the Safe and Well Led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

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 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 rela

Inspection carried out on 4 September 2018

During a routine inspection

Kingston Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

Kingston Nursing Home provides 47 beds for older people who require nursing care, some people were living with dementia. It is situated close to Roundhay Park in North Leeds.

At our last inspection in January 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This inspection took place on 4 and 5 September 2018.

Systems and processes were in place to keep people safe and risks associated with people’s care needs had been assessed. There were sufficient staff to meet people’s needs and recruitment processes and procedures were robust.

Medicines were managed safely. People’s nutritional and healthcare needs were met.

Staff received appropriate induction, training and supervision to provide safe and effective care. The registered manager worked in partnership with other organisations to support people’s needs.

Staff knew people well and care plans were, detailed and provided staff with guidance on how to meets people’s needs. Observations showed staff were caring and patient. The registered manager and staff explained they knew people well and were in the process of recording, where necessary, people’s end of life wishes. Staff respected people privacy and dignity and encouraged people to remain independent. A range of activities were available for people to take part in.

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

People and relatives could express their views about the running of the home. They said the registered manager was approachable and listened. Staff said the home was well-run and the registered manager was supportive.

Complaints and concerns were managed appropriately and outcomes were actioned. People and relatives knew how to make a complaint. Infection control management was robust. There was evidence of effective checks being carried out to assess and monitor the quality of the service provided.

Further information is in the detailed findings below.

Inspection carried out on 27 January 2016

During a routine inspection

Kingston Nursing home provides 47 beds for older people who require nursing care some of whom are living with dementia.

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 and associated Regulations about how the service is run.

Overall, people told us they felt safe and well looked after. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely. We found there were systems in place to protect people from risk of harm and appropriate recruitment procedures were in place.

There were policies and procedures in place in relation to the Mental Capacity Act 2005. Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were made in their best interests.

There were enough staff to keep people safe. Staff training and support provided staff with the knowledge and skills to support people safely. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity.

People told us they got the support they needed with meals and healthcare. However, some improvements were needed to ensure the meal time experience was positive for all people who used the service. Health, care and support needs were assessed and met by regular contact with health professionals who spoke highly of the service.

People were provided with social activities and development of personalised activities were underway.

There were systems in place to ensure complaints and concerns were fully investigated. People had the opportunity to say what they thought about the service and the feedback gave the provider an opportunity for learning and improvement.

People were not put at risk because systems for monitoring quality were now effective. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

Inspection carried out on 16 October 2014

During an inspection looking at part of the service

This was an unannounced inspection on 16 October 2014.

Kingston Nursing home provides 47 beds for older people who require nursing care some of whom are living with dementia.

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 and associated Regulations about how the service is run.

People who used the service told us they were very happy living at the service. They said they felt safe and knew how to report concerns if they had any. We saw care practices were good. Staff respected people’s choices and treated them with dignity and respect. People were encouraged to maintain good health and received the support they needed to do this. Medication was managed safely and people received their medication when they needed it.

People were not deprived of their liberty unlawfully. The registered manager and provider were aware of their responsibilities regarding the Deprivation of Liberty Safeguards.

People told us they enjoyed the food in the home and there was a good variety of choices available. We suggested improvements could be made to try and ensure meal times were more of a social occasion for people.

People told us they did not always have enough to do and would like more stimulating activity. Our observations on the day of our visit, showed people were not engaged in meaningful activity or socialisation. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Staff said they felt well supported in their role and knew what was expected of them. However, some staff did not receive regular one to one supervision to enable them to discuss their role and learning needs. Staff had received training on the Mental Capacity Act 2005 but could not all show their understanding of this and how they would protect people’s rights. The provider confirmed further training was being arranged.

We found people were cared for, or supported by, sufficient numbers of suitably qualified, skilled and experienced staff. There was an on-going training programme in place for staff to ensure they were kept up to date and aware of current good practice. Robust recruitment procedures were in place and appropriate checks had been undertaken before staff began work.

Staff and people who used the service spoke highly of the management team; saying they were approachable. However, we found that systems in place to monitor the quality of the service were not always fully effective to ensure continuous improvement in the home.

People told us they were confident to make a complaint if they needed to. Staff were aware of how to support people to raise concerns and complaints and we saw the provider learnt from complaints and suggestions and made improvements to the service.

Inspection carried out on 6 November 2013

During a routine inspection

The service cares for and supports people with a wide range of complex needs. They were not all able to verbally tell us their experiences. We therefore used a number of different methods to help us understand the experiences of people who used the service, including observing the care being delivered, talking with staff, interacting with people who used the service and looking at records in the home.

We saw that people were comfortable and at ease with staff and were supported to make choices to enhance their independence. We saw that staff were responsive to people�s needs and requests for assistance.

We spoke with six people who used the service or their relative. They said they were satisfied with the home and enjoyed life there. They were also very complimentary about the food. Comments included:

�I am treated very well here, very well looked after thank you.�

�I like it here, suits me very well.�

�I enjoy the entertainers we have and the singing service.�

�The food is very good and plenty of it, they are always coming round with something.�

�The meals are very good and we can have a drink whenever we want one.�

We spoke with seven members of staff; this included the provider and Registered Manager. Staff said the home was well managed and they had enough staff to meet people�s needs well and with dignity.

People were protected from unsafe or unsuitable equipment because the provider had systems in place to make sure equipment was properly maintained, suitable for its purpose and used correctly. Staff and people who used the service said they had all the equipment they needed.

People who used the service said there were enough staff to meet their needs. They spoke highly of the staff and how they were treated by them. Comments included:

�I find all the staff very nice and pleasant.�

�They are friendly and polite.�

There were systems in place to ensure people were protected because accurate and appropriate records were maintained.

Inspection carried out on 27 November 2012

During a routine inspection

Some people were not able to verbally tell us their experiences. We therefore used a number of different methods to help us to understand the experiences of people who used the service, including talking with people, looking at records and observing the care being delivered. People said they were happy living at the home and they were well looked after. Comments included:

�We all get on so well here, like one big happy family.�

�The staff are wonderful, treat us very well.�

�I am so happy here, always plenty going on, staff are wonderful.�

�There�s a lovely, lively atmosphere here, plenty of staff and always so helpful to everyone.�

People we spoke with or their relatives said they understood their care and support plans and that staff had explained things well to them. One relative said they felt very involved and communication from the service was very good.

People looked well cared for and were responded to promptly when they asked for any support or assistance. We saw staff interacting with people in a respectful and caring manner. They showed warmth and patience. People said they received their medication when they needed it. One person said, �They always bring it to you and wait with you while you take it.�

People who used the service and their relatives were complimentary about the staff. One said, �The staff are wonderful and always so cheerful.�

People said they were aware of how to make a complaint if they needed to do so.

Inspection carried out on 25 January and 1 February 2012

During an inspection looking at part of the service

During the visit we had the opportunity to talk to one person living in the home and one person who was visiting a relative. They told us they were happy with the care and support. The said the staff were �very good�, listened to them, and the visitor told us they were always made welcome. People told us the food was very good. They said there were activities in the home and trips out several times a year. They told us the home was clean.

Inspection carried out on 4 October 2011

During an inspection in response to concerns

Many of the people at the home are living with dementia and we were not able to understand from our conversations, their views on the home.

One person told us that staff are nice but they don�t always listen to what they have to say.

Inspection carried out on 28 March 2011

During a routine inspection

�We can decide when we want to get up and go to bed, do what we want and the staff are always nice to us�.

�The staff ask me about things, what I want to eat or do�.

�The people who work here are nice there are no silly rules�.

�The staff let me talk to them, they ask me questions about how I am, the doctor is nice to�.

�I am very happy here�.

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