10 December 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was undertaken by three inspectors, one of whom was a medicines inspector, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Kings Lodge Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with 11 people who used the service, four relatives and a friend of one person at the service, about their experience of the care provided. We spoke with 11 members of staff including the registered managers, deputy manager, two registered nurses, chef, three care staff and two activities co-ordinators.
We reviewed a range of records. This included eight people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at memory assessment records, self-administration medication documents, and care plans relating to medication and people living with a learning disability.
10 December 2021
About the service
Kings Lodge Nursing Home is a residential care home providing personal and nursing care to 67 older people with a variety of health needs at the time of inspection. One part of the home provides specialised care for people who were living with dementia. The service can support up to 77 people.
People’s experience of using this service and what we found
Medicines were not always administered or stored in a safe way. New admissions to the home were not managed in line with government guidance. Some infection prevention and control systems were not sufficiently robust to protect people from unsafe care or treatment.
Care plans for some people with a learning disability did not provide detailed information or guidance for staff to ensure they received person-centred care.
People told us they felt safe living at the home. The home was open to visitors. A friend of one person was visiting the home and told us, “We were able to visit in the pod. It wasn’t ideal, but at least I was able to see her again. It was so important that we could visit”. Staffing levels were sufficient to meet people’s needs and new staff were recruited safely.
People’s needs were assessed before they came to live at the home. 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.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
• Model of care and setting maximises people’s choice, control and independence
Care records lacked information for staff as to how people’s independence could be promoted, or how to support people to have choice and control of their lives.
• Care is person-centred and promotes people’s dignity, privacy and human rights
Staff knew people well and provided personalised care. However, records did not show how staff should promote people’s dignity and privacy or protect their human rights.
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives
There was no evidence to show how the home promoted inclusion in order for people to feel empowered.
The registered manager was not aware of the principles of Right support, right care, right culture. On the second day of inspection, they told us they had accessed this strategy and would be reviewing the care, including records, that people living with a learning disability or autism received.
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 Good (published 3 November 2018).
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.
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 Good to Requires Improvement. This is based on the findings at this inspection. The provider has taken some action to mitigate the concerns
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kings Lodge Nursing Home 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 monitor the service.
We have identified breaches in relation to the safe administration and management of medicines, infection prevention and control, and governance. Please see the action we have told the provider to take at the end of this report.
We will request an action plan from 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.