Kingsthorpe Grange

Kingsthorpe Grange is a nursing home providing personal and nursing care for to up to 51 people. The service provides support to people living with dementia and other mental health conditions. At the time of our inspection there were 37 people using the service.

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

Systems and processes in place to monitor the quality and safety of the service had failed to identify and address concerns found during the inspection. The provider had failed to implement effective systems to comply with CQC regulations.

Further improvements were required to ensure risks to all people living in the service were identified and mitigated.

Relatives told us people’s clothing and personal items often went missing. During the inspection we saw unlabelled clothing and underwear in the laundry room and within people’s individual wardrobes.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People had care plans in place detailing the care and support they needed from staff however, these were not always personalised and required further development.

People’s medicines were administered by trained and competent staff and medicines were ordered, stored and disposed of safely.

People and their relatives told us staff treated them with kindness. Staff respected people’s privacy and dignity when supporting people with personal care.

Staff worked effectively with other healthcare professionals and people told us their healthcare needs were managed well.

People and the relatives we spoke with during the inspection told us they felt safe and there was enough staff to meet people’s needs and keep them safe. Staff received training on safeguarding and understood how to recognise and report abuse. Staff told us that they would report any concerns to the nurses or manager.

We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.

People were supported to eat and drink enough to maintain a balanced diet. The provider ensured staff received training to understand the individual needs of the people supported at the service.

People and their relatives were given the opportunity to provide feedback on their care for improvements to be made. Staff told us they felt valued in their roles and received support from their colleagues and the manager.

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 requires improvement (published 20 September 2023) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsthorpe Grange on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, dignity and respect, and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Kingsthorpe Grange is a nursing home providing personal and nursing care for to up to 51 people. The service provides support to people living with dementia and other mental health conditions. At the time of our inspection there were 50 people using the service.

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

Not all risks to people had been assessed to ensure any potential risks to people were mitigated. Systems and processes in place to monitor the quality and safety of the service required further development to identify and address the concerns found during the inspection.

We found concerns in relation to the management of medicines. For example, people who were on time sensitive medicines such as for Parkinson's disease did not always receive them at the same time each day. People’s medicines were administered by trained and competent staff and medicines were ordered, stored and disposed of safely.

People’s relatives told us that their loved one did not always wear their own clothes and people’s clothing provided by the relatives often went missing. People were at risk of feeling cold or uncomfortable whilst in bed as they did not have suitable bedding made available to them at all times.

There was limited signage to support people to orientate themselves around communal areas, clocks in people’s rooms were displaying the incorrect time of the day and people’s names were not always on their bedroom doors.

Important information about people’s life history, interests, likes and preferences was not always recorded in people’s care files. This meant we could not be assured staff knew people well enough to provide personalised care.

People and their relatives told us staff treated them with kindness. Staff respected people’s privacy and dignity when supporting people with personal care.

People and the relatives we spoke with during the inspection told us they felt safe and there was enough staff to meet people’s needs and keep them safe. Staff received training on safeguarding and understood how to recognise and report abuse. Staff told us that they would report any concerns to the nurses or registered manager.

We were assured that the provider was making sure infection outbreaks could be effectively prevented or managed.

People were supported to eat and drink enough to maintain a balanced diet. The provider ensured staff received training to understand the individual needs of the people supported at the service.

People and their relatives had the opportunity to provide feedback on the care and support provided and staff told us they felt valued in their roles and received support from their colleagues and the registered manager.

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 requires improvement (published 12 August 2022).

Why we inspected

The inspection was prompted in part due to concerns received from other professionals in relation to people’s health and wellbeing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsthorpe Grange on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, medicines, and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Kingsthorpe Grange is a nursing home registered to provide care for up to 51 people living with mental health conditions and dementia. At the time of the inspection 34 people were living in the home.

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

Systems to monitor the quality and safety of the service were in place to ensure people received safe and person-centred care. These required time to be embedded in the service to ensure they were sustained and improvements continued.

Risks to people’s care had been identified but some plans in place to mitigate the risk were not always sufficiently detailed enough to provide the level of information staff required to support people safely.

Staff understood how to protect people from harm and followed good hygiene practices to prevent and control infection. There were sufficient staff deployed to meet people’s needs and people could be assured staff were recruited safely.

People could be assured they received their medicines as prescribed. Staff received training in managing medicines and their competencies had been checked.

People's needs were assessed, and care plans guided staff how to meet those needs. A system was in place to monitor people’s health needs, this needed to be embedded and sustained.

People were supported to eat and drink. Mealtime experience could be improved to provide a more social environment.

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.

Refurbishment plans were in place and improvements to the environment had been made. This needed to be sustained and improvements continued.

Feedback from families and visitors to the home was sought to help drive the improvements needed.

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 inadequate (published 11 January 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 10 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 carried out an unannounced comprehensive inspection of this service on 24 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staff training, nutrition, dignity and management of oversight.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsthorpe Grange on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kingsthorpe Grange is a nursing home registered to provide care for up to 51 people living with mental health conditions and dementia. At the time of the inspection 46 people were living in the home.

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

The provider failed to have sufficient managerial oversight of the service. There was a failure to implement and embed systems to monitor people’s health and welfare and ensure all systems were in place to prevent and control the risk of infection.

People were at risk of undetected ill-health as staff did not complete clinical observations or recognise when people were showing signs of ill-health. People were at risk of not being referred to medical care in a timely way.

The provider did not have a system to monitor staff knowledge and skills in monitoring peoples’ health, diabetes management, infection prevention and control, caring for people after a fall and safe nutrition and hydration.

People were at risk of choking and aspiration as staff did not have the information about people’s dietary needs; staff did not always provide people with food and drink that safely met their needs. The provider’s audits did not identify where people had not received food and drink that met their needs.

People were at risk of harm due to accessing areas with hot pipes, hot water and cleaning products. The provider’s audits had not identified any health and safety or environmental issues.

People’s belongings and personal records were not always stored securely. The provider did not have a reliable system to manage people’s belongings or reunite people with their lost property when they had been found.

People who found it difficult to communicate verbally did not have the opportunity to communicate using other methods such as pictures or technology.

The provider’s policies did not always consider the use of best practice guidance to provide sufficient information and guidance for staff to provide safe care.

The provider ensured there were enough staff on duty to provide care. There was ongoing recruitment in key roles.

People received their medicines as prescribed. Staff received training in managing medicines and their competencies had been checked.

People were protected from abuse as staff knew how to recognise the signs of abuse and who to report their concerns to. The manager had raised safeguarding alerts appropriately and worked with social workers to investigate concerns.

People and relatives had information on how to make a complaint. The manager had responded to complaints in line with the provider’s policy. The provider used information from complaints to inform them how they could improve the service.

People’s independence was promoted where possible. 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.

During the inspection the provider created a task force of personnel who visited the home on the second day of the inspection. The task force was deployed to assess, monitor and manage the changes required in health and safety, training and competencies of staff, updating audits, clinical practices, safeguarding and records. The provider supplied evidence if the immediate changes that had been made and their plans on how they were to implement systems and monitor these in the future.

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 Requires Improvement (published 22 July 2021).

Why we inspected

The inspection was prompted in part due to concerns received about the level of people’s personal hygiene, nutrition, wounds and medicines. A decision was made for us to inspect and examine those risks.

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.

At the last inspection the provider was in breach of regulations relating to safe care and treatment and managerial oversight. We asked the provider to send us action plans to show what they were doing to implement and sustain improvements. The provider told us they would be compliant with these regulations by 30 September 2021.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. We have identified five breaches in relation to safe care and treatment, staff training, nutrition, dignity and management oversight.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsthorpe Grange on our website at www.cqc.org.uk.

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 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.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kingsthorpe Grange is a nursing home registered to provide personal and nursing care for up to 51 people living with dementia and/or mental health needs. At the time of inspection there were 48 people residing at the service.

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

Systems and processes to ensure oversight of the service required improvement. Audits were not effective in ensuring completed records were in place and some audits had not been completed regarding reviewing daily tasks.

People were at risk due to care plans not always being in place. Risks to people had not been consistently recorded or strategies implemented to reduce the known risks to people.

People received medicines from staff who received training and understood a person had the right to refuse medicines. There were some recording issues with medicines. However, we found people did received their medicines as prescribed.

People, relatives and staff were supported to feedback about the service and understood how to complain and felt they would be listened to.

People were supported by staff who had been safely recruited and received appropriate training to complete their roles.

People were protected from abuse. The systems and process were in place and staff understood how to recognise and report and concerns.

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 good (published 08 August 2019).

Why we inspected

We received concerns in relation to safeguarding. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsthorpe Grange on our website at www.cqc.org.uk.

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.

We have identified breaches in relation to risk assessments and care plans, medicine management and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ The provider had identified a specific area within the service to ensure effective use of cohorting and zoning for people who tested positive for COVID-19. That meant people had rooms and facilities in a certain area of the home, which reduced the potential for the infection to spread. Staff were appointed to work in designated areas which further reduced the potential for transfer of infections.

¿ Risk assessments and procedures were in place for admitting people in to the building. All people entering the building were temperature tested and completed hand disinfection. .

¿ The provider ensured plentiful supplies of personal protective equipment (PPE). This included face masks and aprons and we saw staff used these appropriately. Staff were encouraged to change their PPE regularly. Used PPE was disposed of in foot operated pedal bins situated throughout the home which reduced the potential for transfer of infection. There was a designated area for putting on and taking off PPE before entering designated floor.

¿ Staff encouraged people to wash their hands frequently throughout the day. Where this was not possible, hand sanitiser was offered as a means to reduce the transfer of infection.

¿ The provider participated in regular COVID-19 testing of people living in the service and staff. That ensured action could be taken swiftly to reduce the potential spread of infection if a positive test was returned.

¿ Areas were cleaned and disinfected with cleaning products approved to reduce the potential transfer of infection.

¿ Risk assessments had been completed to protect people and any staff who may be at a higher risk of contracting Covid-19, measures were in place to support them.

¿ Staff worked in set teams with staff working in defined areas, which lessened the potential of cross infection within shift members.

Further information is in the detailed findings below.

People’s experience of using this service:

Staff and the management understood the importance of safeguarding people from the risks of abuse. The manager followed the safeguarding reporting procedures, through reporting concerns about people’s safety or welfare to the local safeguarding authority and to the Care Quality Commission (CQC).

Risk assessments were completed and updated as and when people's needs changed. We found the risk assessment for one person at risk of self-harm did not contain full details about the items the person could use to self-harm. In addition, their observation records did not evidence the engagement staff had with the person.The manager immediately arranged for the risk assessment, observation record and care plan to be fully updated with the specific details on how staff supported the person from the risks of self-harm.

Staff safely administered and managed people’s medicines. However, closer monitoring was needed regarding the administration of medicines prescribed to be taken ‘as required’ (PRN). The manager immediately put in place a recording tool for staff to specifically record the reason, and time when PRN medicines were administered. This meant closer monitoring of the use of PRN medicines could take place. The manager also confirmed they were in discussion with the company that provide the electronic medicines administration system, to have such a feature incorporated onto the system.

Staff recruitment procedures protected people from the risks of receiving care from unsuitable staff. Staff received appropriate induction and ongoing refresher training and support to carry out their roles. Staffing arrangements ensured people received timely support from a consistent team of staff that knew their care and support needs. Staff followed good practice infection control guidelines to help prevent the spread of infection.

People received a varied diet to ensure good nutrition and hydration. They had access to timely healthcare to maintain their health and wellbeing. People and their representatives were involved in making decisions about their care and support needs. 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.

People and their representatives were involved in the planning and development of their care and support. Staff were skilled at enabling people to communicate their choices and decisions. They knew people well and used this knowledge to provide personalised care. They respected and promoted people's privacy, dignity and independence. People were supported to access the local community and maintain relationships with friends and family. Systems were in place to receive and respond to complaints.

People, visitors and staff were encouraged to share their views about the service. Feedback received was used to continually drive improvement. The provider and manager were open and transparent in sharing information about actions taken and lessons learnt within the service. The manager and staff ensured people were provided with good care and support to achieve the best possible outcomes. They worked in partnership with a range of health and social professionals to achieve this.

Systems were in place to continually quality monitor all aspects of the service. The provider and manager were open to advice and took immediate action on areas identified for further improvement.

Rating at last inspection

At the last inspection the service was rated Good (report published 3 December 2016).

Why we inspected

This was a planned inspection based on the rating of the service at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 2008 and associated Regulations about how the service is run.

People felt safe living in the home. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required to keep them safe and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job. People had risk assessments in place which identified and managed people’s known risks, and appropriate arrangements were in place to manage and store people’s medicines.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People had their healthcare needs managed in a way that was appropriate for each person and people’s nutritional needs were well supported.

People received support from staff that treated them well and prioritised their needs. People were relaxed and comfortable around staff and staff understood the need to respect people’s confidentiality. People were supported to maintain good relationships with people that were important to them and the home had good links with advocacy services to ensure people had the support they required.

People were encouraged to make their own personal choices and to be in control of their own lives. The Registered Manager was making progress to ensure people’s care plans reflected people’s interests. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People at the home reacted positively to the manager and the culture within the home focussed upon supporting people to receive the care they needed and to be as independent as possible. Systems were in place for the home to receive and act on feedback and policies and procedures were available which reflected the care provided at the home.

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found that risk assessments identified individual risks, to people's health, safety or welfare. People's care records and risk assessments were regularly reviewed and updated as and when their needs changed. The staff received appropriate training to ensure they had the skills and knowledge to meet people's needs.

Is the service effective?

Effective systems were in place to monitor the management of the service. People's care plans and risk assessments were regularly reviewed and updated as and when people's needs changed. We saw that quality assurance systems were in place to ensure people received effective care that was right for them.

Is the service caring?

We observed positive interactions between staff and people using the service. We saw the staff were patient, kind and genuinely warm towards the people they were supporting.

We noted over the lunchtime the staff provided assistance for people who required help to eat and drink. We observed the staff offering the assistance in a sensitive way. However the provider may wish to note we also observed one member of staff blowing on a person's food to cool it down before spoon feeding the person. Whilst well meant, we considered this action was indelicate in preserving the person's dignity and unhygienic.

We spoke with five people who told us they were happy with the care and treatment they received. They also told us they felt safe. One person said, "The staff are very good. They check on me when I can't sleep at night." Another person said, 'The staff are nice and caring.' This supported our observations that people appeared well supported, happy, and comfortable in the company of the staff.

The staff we spoke with were knowledgeable about the needs of the people they supported. We observed that they were responsive to people's needs, and treated people with respect. One staff member said, 'I like it here. I enjoy my job because I like helping people.'

Is the service responsive?

It was clear from our observations that staff knew the people who used the service well, and they were attentive to their needs throughout. We saw that people's physical and mental health was closely monitored and appropriate action was taken in seeking the advice and guidance of health and social care professionals. The provider may wish to note, a visiting healthcare professional, told us that call outs to the GP surgery could be better co-ordinated between the RMN staff. For example, the surgery sometimes received several calls on the same day from the nursing staff requesting GP visits.

Is the service well-led?

The registered manager and the staff we spoke with were clear about their roles and responsibilities. We found that regular quality audits were carried out by the manager, other senior staff and a senior representative from within the company. We saw that the quality audits included checks of people's care records; risk assessments, accidents and incidents, medication records and health and safety and checks of the home environment. We found that action plans with timescales were produced and completed for all areas identified as needing attention. This meant there were effective systems in place to regularly assess and monitor the quality of service that people received.

People living in the home expressed satisfaction with the care and service they

received. They told us they were well looked after by all the staff and one person

told us that they liked this home better than their previous placement. They also told us they were able to have cultural food that they enjoyed.

Another person said 'It's nice here and the care staff are nice too'. They also told us they knew how to make a complaint and said 'I will speak to the staff in the office and I know they will listen to me'. People also told us that the activities in the home were very good and they joined in with some of the sessions.

We also spoke with a relative who told us that the 'People living at the home did lots of activities and the place was lovely and very clean'. They also said 'The staff are fantastic and very caring' and they observed care staff speak to people in a kind and dignified manner.

We observed that all staff on duty had a calm and kind manner when working with

individual people. Several people were not able to hold meaningful conversations

with us, but we saw from their responses and body language that they were happy

with the way staff treated them.

We found the provider had systems in place to meet people's health and welfare needs. People had individual care plans which were supported by risk assessments and daily care records to meet their needs. We also found that medicines were handled safely. We saw that the provider had a complaints system in place to ensure that any complaints raised were handled appropriately.

People living in the home expressed satisfaction with the care and service that they received. They told us that the home was 'homely' and staff looked after them well. One person told us 'I like it here and the staff are lovely' and they spoke to them in a dignified manner. Another person told us 'we do lots of activities and I like cooking best because we can taste the food'.

We observed that all staff on duty had a calm and kind approach when working with individual people. Several people in the dementia unit were not able to hold meaningful conversations with us, but we saw from their responses and body language that they were happy with the way staff were treating them