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Kings Lodge Nursing Home Good

All reports

Inspection report

Date of Inspection: 10 September 2014
Date of Publication: 31 October 2014
Inspection Report published 31 October 2014 PDF

There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 10 September 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members and talked with staff.

We spoke to health professionals.

Our judgement

There were not enough qualified, skilled and experienced staff to meet people’s needs.

Reasons for our judgement

We looked at the staff rotas for one month and found that the staffing levels were the same throughout the week. There were two registered nurses on each shift and nine to ten care staff, in addition there were activity, housekeeping and catering staff. The manager and operations manager said they were available to cover if nurses were on leave or absent from work. The manager said the staffing levels were flexible and were based on meeting the needs of people who lived at the home. People on both of the units at Kings Lodge had a range of care and support needs. These included people with a diagnosis of dementia type illness; those with nursing care needs or personal care and support needs, and people with and without capacity to make decisions about their care. However, they were unable to show that a tool or system had been used to ensure that there were enough staff, with the relevant skills, expertise and understanding of people’s needs working at the home. There was no evidence to support the managements view that staffing levels were based on the needs of people who lived at the home.

Staff spoken with said they felt there were enough staff working on each shift.

People we spoke with said they did not have any concerns about staffing levels. They told us they felt that staff looked after them very well. A visitor said, “Yes everything is fine. Staff attend when they are needed”. A relative told us they were, “Over the moon with things”.

We sat in the lounges reading the care plans and daily records, and we observed staff providing care in all areas of the home, including the dining room. In addition, we observed the interaction between people and staff at different times throughout the inspection.

From direct observation we found that staff supported people, who needed their assistance, with moving around the home and with personal care. However, we found that staff did not interact with some people unless they were providing support or care. For example, we saw that there were long periods at supper time when some staff were giving out meals and assisting people, but did not talk to them as they provided support. This meant that staff failed to involve people in decisions and discussions about the support provided. In addition, staff did not encourage people to interact socially and develop conversations, during one of the few times of the day when people sat in small groups for a reasonably long time, and had opportunities to talk to staff and each other.

Most of the people had a dementia type illness, and although there was evidence that staff had attended training, we saw that staff had not provided appropriate support for some people. For example, we saw that one staff member continued to assist a person with soup, although they had told them it was too hot. This meant that the staff member had not taken into account the person’s comment, and other staff intervened. We spoke with a team leader about the systems that were in place to observe staff practice, which ensured they provided appropriate care and support. We were told that they did not have the time to observe each staff members practice. This meant that there were no clear systems in place to observe and assess that staff had the skills and knowledge to provide the care and support people needed.

We spoke with a relative and friends of people who were assisting them with their lunch. They told us the meals were very good and that staff were very helpful and supportive. However, one visitor also said they visited particularly at lunch time to ensure that people had the meals, because they needed assistance. In addition, they said that although there should be at least one member of staff in the lounge at all times to make sure people were safe, there were times when staff were not available and visitors, “Keep an eye on people and call staff if we are worried”. We saw that call bells were responded to and the lounges were staffed. From direct observa