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Archived: Kingsley Rest Home Inadequate

Reports


Inspection carried out on 7 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The Care Quality Commission (CQC) conducted this inspection on the 7 July 2014. At the time of this inspection the registered provider with CQC was Robert David White and Lesley Karen White. Since the date of the inspection a new provider and manager has been registered with the Commission to carry on the service at this home. This report is being published in the name of the provider who was registered with the Commission at the time of the inspection undertaken in July 2014 to comply with its publication duty. All references to the provider in this report relate to Robert David White and Lesley Karen White and the registered manager registered with the Commission at the time.

Our inspection was unannounced which meant the provider did not know we were coming.

We identified that the provider who was registered with the Commission at the time of the inspection was not meeting the legal requirements associated with the Health and Social Care Act 2008 during an inspection on 17 December 2012. Since that inspection that provider had not made the improvements required to raise standards in the service.

When we inspected Kingsley Rest Home on 30 December 2013 we found that; care was not always delivered in a manner that protected peoples safety and welfare, medicines were administered unsafely, care records did not contain the information required to enable staff to meet people’s needs in a safe and consistent manner and effective systems were not in place to assess and monitor the quality of care. The provider made improvements to the way medicines were managed, but the other required improvements have not been made.

Kingsley Rest Home provides residential care and support for up to 12 older people, some of whom may have a diagnosis of dementia. At the time of our inspection 10 people used the service. There was a registered manager in post at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We found that improvements were needed to ensure people received their care safely. Risks to people’s health and wellbeing were not always adequately assessed or recorded, and accurate and up to date information about people’s risks was not always available for the staff to follow.

The provider could not show that the required staff recruitment checks had been completed. Therefore they could not assure the people that the staff were suitable to provide them with care and support.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not being followed. Some people who used the service did not have the ability to make decisions about some parts of their care and support. The Mental Capacity Act 2005 sets out requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. The staff had not received sufficient training to enable them to follow the legal requirements of the Act and the DoLS. The provider told us no one who used the service required a DoLS authorisation. However, we identified one person who was potentially being deprived of their liberty.

Care was not always planned for or delivered in a manner that met people’s individual care needs. People’s behaviours were not adequately monitored to identify changes and professional advice was not always sought when people’s needs changed. This meant people could not be assured that they were getting the right care for their needs.

The staff’s development needs were not being assessed or monitored by the provider. Staff had not received the training they required to meet people’s needs, and the provider did not have an effective system in place to supervise and support the staff’s development needs.

People told us their needs were met in a timely manner with dignity and respect. However some people told us that people who displayed behaviours that challenged others, such as aggression and agitation were not always treated in a caring manner by the staff. This was because the staff had not been trained in how to manage people’s complex behaviours.

Staff were aware of people’s likes, dislikes and care preferences. However some people’s bathing preferences had not been met for a significant period of time because the bath was out of action. The provider had not taken responsive action to ensure equipment and facilities were maintained to meet people’s bathing preferences.

The provider had started to involve people who used the service in the evaluation of the care. More improvements were required to ensure people were involved in the evaluation of all aspects of the care and contribute to the development of the service.

Effective systems were not in place to enable the registered manager or provider to assess and monitor the safety and effectiveness of the care. The concerns with the care we identified at this inspection had not been identified by the registered manager or provider registered at the time of the inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Our findings have been shared with the new provider who has submitted a plan to us detailing the actions they are taking to make improvements to care delivery.

Inspection carried out on 7 July 2014

During Reference: R6 not found

Inspection carried out on 12 March 2014

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

During our last inspection on 30 December 2013 we found the service was non-compliant in relation to the management of medicines. This meant the registered provider needed to make improvements in this area to ensure that people who used the service received the essential standards of care. We served a warning notice and asked the provider to make these improvements by 10 February 2014.

We found that the provider had made improvements to the way they managed medicines. We observed how people received their medicines and found that medicines were administered and stored safely. We saw that staff had attended training for the safe administration of medicines.

Inspection carried out on 30 December 2013

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

At our last inspection on 20 June 2013, we identified that improvements were required to ensure people received safe, effective and responsive care. We completed this inspection to identify if the required improvements had been made. We also completed a themed inspection alongside this inspection which looked at how the needs of people with dementia were met. This inspection can also be found on our website.

During this inspection we spoke with eight people who used the service and three relatives. We also spoke with two members of staff, the registered manager and the deputy manager.

We saw that a system was now in place to enable the registered manager to identify if people were able to consent to their care and support. Where people could not consent, decisions were made in people�s best interests in line with legal guidance.

People told us that they were now offered choices at meal times and people felt happy to ask for alternative meals if they did not like the choices offered.

We saw that people remained at risk of receiving their medicines in an unsafe and inconsistent manner, because effective systems to protect people from the risks associated with medicines were not in place. We have asked the provider to take immediate action to address this.

We also saw that people remained at risk of receiving unsafe or inappropriate care because their care records did not always describe how their care should be delivered.

Inspection carried out on 30 December 2013

During a themed inspection looking at Dementia Services

This themed inspection was completed alongside a follow up inspection. The follow up inspection report can also be found on our website.

At the time of our inspection there were ten people who used the service. Staff told us that two of these people had a diagnosis of dementia, and four people showed signs of dementia. We spoke with six people who used the service, and three relatives. We also spoke with two members of staff, the registered manager and the deputy manager.

People and their relatives told us they were happy with the care. One person told us, �I don�t think you could get a better place�. A relative commented, �We have been very happy with the care X is getting�.

We saw that plans were in place to support people�s physical health needs; however plans were not in place to ensure people received consistent and appropriate support with their mental health and emotional needs.

People told us they had access to healthcare professionals for routine assessments and treatment, but we saw that effective systems were not in place to ensure people had appropriate and consistent access to emergency assessment and support.

The registered manager could not evidence that people�s feedback about their care was sought and we saw that there were ineffective systems in place to enable the registered manager and provider to assess, monitor and improve care.

Inspection carried out on 20 June 2013

During a routine inspection

During our inspection we spoke with five people who used the service, a relative, three members of staff and the registered manager.

We saw positive interactions between the staff and people who used the service and saw that staff met people�s individual needs in a friendly and professional manner. One person told us, �The staff are all very good�. A relative told us, �The care staff are absolutely fabulous�.

At our last inspection we identified that improvements needed to made in the way that consent was gained from people who used the service and how medicines were stored, recorded and administered. During this inspection, we saw that improvements had been made, but further improvements were still required.

We saw that special dietary needs were met, but people were not routinely offered choices of food at mealtimes.

We found that care records did not always contain accurate or up to date information, which meant people were at risk of receiving inconsistent or unsafe care.

At our last inspection we identified that effective systems needed to be put in place to ensure that the quality of care was consistently assessed and monitored so that improvements in care could be made. During this inspection, we saw that some improvements had been made, but further improvements were required.

Inspection carried out on 17 December 2012

During a routine inspection

We spoke with six people who used the service, one relative and five members of staff. We also spoke with a visiting health care professional. People using the service told us they enjoyed living at Kingsley Rest Home and found the staff to be caring. One person said, �It's very nice here, the staff help me with everything I need�. Another person said, �It's very good here, I am very comfortable�. A relative we spoke with told us they were happy with the care their relatives received. They said, �I have confidence in the staff� and �I feel lucky that my relative lives here�.

During our inspection we found that people�s care records did not always contain detailed assessments and plans of care. Assessments had not been made to identify if people had the ability to make decisions for themselves or if they needed support to do this.

We saw that most medicines were kept securely, but there was no effective system in place to ensure that people�s medicines were accounted for. There was also no effective system in place to ensure that people who took their medicines independently did so safely.

We observed people being treated in a caring and relaxed manner by staff who were trained to meet people�s care and welfare needs. Systems were also in place to ensure people�s safety in emergency situations.

During our inspection we identified that adequate systems were not in place to regularly assess and monitor the quality of the service.

Inspection carried out on 29 December 2011

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

We carried out this inspection because we had not visited the service (home) since 2008 and we did not have enough information about the service to assess compliance. We wanted to see what life was like for the people who lived in the home. We also wanted to see whether the service had made any improvements since we last visited.

During this inspection visit we looked at outcomes four and sixteen of the essential standards of quality and safety, under the regulations of the Health and Social Care Act 2008. Outcome four looks at the care and welfare needs of people using the service. Outcome sixteen looks at how the service assesses and monitors the quality of the services that people receive.

The visit was unannounced. This means that the service did not know that we were coming. The registered manager was not on duty at the time of the inspection visit but we spoke with him over the telephone during our visit. One of the providers Mrs White was present throughout our visit.

We observed staff to be attentive to the needs and welfare of people and there was a happy friendly atmosphere at the home. People told us that they felt well cared for by the staff and that it was like �one big family.� All of the people who lived in the home were complimentary about the care and support they received.

People were dressed according to their personal choice and looked warm, comfortable and well cared for.

The service provided staff who had been trained to meet the needs of people living in the home. The staff felt well supported by the service.

The service ensured that people who lived in the home were safe and that the quality of care and support they were receiving was regularly monitored and improved.