Archived: Kings Cottage Residential Home

Kings Cottage Residential Home is a care home which provides accommodation and personal care and support for up to 26 older people, some of whom have dementia. There were 20 people living at the home on the first day of our inspection. The building was split over two floors and people with varying needs lived on each floor.

A registered manager was in post who had been registered with the Care Quality Commission (CQC) since October 2010. 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 registered manager and provider were present at the service throughout our inspection and assisted us with our enquiries.

Staffing levels were low within the service and in order to cover vacant posts the provider and manager were working a variety of roles. No agency staff were being used at the start of our inspection but the provider made arrangements for this support on the last day that we visited so that both the manager and provider could dedicate more time to managing and governing the service. Vacancies existed in key roles across the service. Staff told us they were very tired.

Although staff had received training in key areas they reported that it was not always of a good standard and training could be better. We found staff did not always apply what they had learned. Staff competencies were not checked to ensure that the care delivered was appropriate and safe, and staff received appropriate support.

There was evidence that vulnerable adults were not always protected from unsafe or inappropriate treatment. For example, people were moved and handled unsafely and inappropriately and external specialist input into their care had not been sought by the provider or manager.

Medicines were not appropriately managed particularly those medicines that were prescribed to be administered 'as and when required' (PRN medicines). People did not have medication care plans in place, including plans for PRN medicines, to inform staff about how people needed their medicines to be administered and any personal preferences that they may have had. Recording around the application of topical medicines such as creams and ointments was not robust.

The manager and provider did not recognise or respond to risk. No actions had been taken for example to mitigate against the risks of, for example, people falling or receiving inappropriate moving and handling. One person presented as unwell during our inspection but this had not been identified and acted upon. People living with dementia had not been supported with their behaviours and there was little information in care plans for staff about how to provide effective care to meet such needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. Other than for one person, applications had not been made to the relevant authorising body to assess whether certain individuals qualified to be lawfully deprived of their liberty. There was a lack of documented evidence to demonstrate that care and treatment was delivered in line with the MCA where necessary. This meant we could not be sure that people’s rights to make particular decisions had not been protected, and that decisions made on their behalf had been taken in line with the ‘best interest’ framework of the MCA.

Staff displayed caring attitudes but they delivered care in line with routines that were institutionalised and not caring or respectful. People's human rights were removed and they were controlled in terms of their activities of daily living, especially those people living with dementia. There was a lack of choice in the service and activities were minimal. Care was not person-centred and there was little evidence of people's involvement in their care, especially those people with dementia care needs.

The culture within the home was one of routine and controlling practices. Staff reported that they did not have a voice and they had concerns about people's care. Throughout our inspection we identified concerns relating to a lack of oversight and management. Auditing and other elements of quality assurance that were carried out within the service to assess and monitor the quality of the care and services delivered were limited. The multiple issues we identified at this inspection had not been identified through the providers own quality assurance systems and there was no evidence that monitoring of the service had been on-going since September 2015. We discovered serious shortfalls in the maintenance of records and some people did not have care plans and risk assessments in place to guide staff about how to deliver safe and effective care.

We identified 11 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. We also found the provider was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 relating to the notification of other incidents. We are dealing with this breach outside of the inspection process.

Due to the serious shortfalls in all aspects of the service, we wrote to the provider to request an urgent action plan which stated what actions they would immediately take to improve. We visited the service again on 3 February 2016 and found that sufficient improvements had been made to ensure people’s immediate health, safety and wellbeing at that time. We will continue to monitor the provider’s progress against their action plan and will revisit the service to ensure that people’s health, safety and wellbeing is protected and promoted.

The overall rating for this service is ‘Inadequate’ and the service has therefore been placed in ‘Special measures’. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made 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 to begin the process of preventing the provider from operating this service.

People and their relatives told us they were happy with cleanliness levels within the home. One person said, "It is really lovely here." One relative told us, "There are no problems with cleanliness here." We found that the home was clean, tidy, well maintained and significant improvements had been made to the infection control procedures.

People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes. We found that where necessary, the provider acted in accordance with people's wishes if they did not have the capacity to consent themselves.

We found that people's care and support needs were appropriately assessed and their care was planned. They received care safely, and to an appropriate standard.

We looked at the provider's recruitment process and found that this was robust. There was a structured selection process in place which aimed to ensure staff were suitably skilled, experienced and qualified to deliver care safely. Appropriate checks were conducted before staff began work to ensure people's safety.

We saw the provider had a complaints policy and procedure in place, which people had access to.

However, although people who received care and support at Kings Cottage told us they were happy, and we saw they were well supported, we found that failures to maintain and manage cleanliness and infection control, may put people's safety at risk.

We walked around the building and the grounds, although we did not discuss this essential standard with people who were using the service.

We found that individual's bedrooms, and communal living areas, were maintained and refreshed. However, flooring in communal bathrooms was unsuitable, and people were not always protected from risks associated with unsafe premises.