Archived: Kingsacre Care Home

Updated 6 May 2017

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.

This inspection took place on 9 and 13 February 2017 and the first day was unannounced. One adult social care inspector and an Expert by Experience undertook the inspection on the first day. One adult social care inspector completed the inspection on the second day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed information we held about the home including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law. We received information from the local authority’s quality assurance and improvement team (QAIT) about the work they were carrying out at the home and we spoke with them about their recent involvement.

We spoke with 13 people living at the home and eight relatives. We spoke with the provider and the manager, as well as two nurses, ten care staff and the cook. We also spoke with a visiting health professional. We looked at three care plans and records relating to staff recruitment and training, accidents, as well as those relating to the management of the home. We spent time observing the care and support people received, including staff supporting people with their moving and transferring and giving people their medicines.

Updated 6 May 2017

Kingsacre Care Home is a nursing and residential care home which provides nursing and personal care to adults. The home is registered to accommodate a maximum of 34 people. On the day of this inspection 29 people were living at the home.

We carried out this unannounced inspection of Kingsacre Care Home on 9 and 13 February 2017. The home was previously inspected in November 2014 when it was rated as good in all five key questions.

At the time of this inspection the home did not have a registered manager. A new manager had started working at the home in December 2016 and confirmed they had made an application to register with us. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Since the previous inspection in November 2014 there had been changes to the management structure at the home and the home had been without a registered manager for some time. The systems previously in place to monitor the quality of the service and to ensure people received safe care were no longer being used effectively. While we found people’s personal care needs were being met and people were happy living at the home, we identified a number of areas that required improvement to ensure people received safe care and support The new manager had identified some of the concerns we found during this inspection.

Risks to people’s health and safety were not being managed and people were not being protected from the risk of avoidable harm. When we arrived at the home on the first day of the inspection we found many of the doors to people’s bedrooms and the communal areas, including the kitchen, were held open. Staff had used furniture and wooden wedges to hold these doors open. This meant that, should a fire break out, these doors would not close and therefore people would be placed at risk of smoke inhalation and the spread of fire would not be slowed by the doors. Also, when the furniture and wedges were removed, many of the doors would not have been effective in reducing the spread of smoke and fire as they did not fully close.

Records of the servicing of some equipment was either out of date or was not available. For example, the gas safety certificate was due to be renewed in May 2015 but this had not been undertaken. A number of other maintenance issues also required attention or review. The carpet in the lounge room required repair as the join had come apart and it posed a trip hazard. Some bedroom furniture was unstable and could be pulled over. The laundry room had peeling paintwork and debris on the floor which made this room difficult to keep clean. On the second day of the inspection we saw repair work being carried out to the doors and the provider gave assurances other action would be taken to ensure people’s safety. We also asked the manager to review the risks to people’s safety of uncovered radiators and the use of a portable ramp to assist one person from their room. Following the inspection the manager confirmed action had been taken to address the identified safety issues.

Staff recruitment practices were not safe. It was not possible from the information held in the staff files to ascertain whether checks had been completed properly and staff had been recruited safely. For example, where staff had gaps in their employment history, this had not been explored and one member of staff’s references were unsigned and undated. However, disclosure and barring (police) checks (DBS) had been undertaken.

Care plans were insufficiently detailed to describe people’s care needs. Staff were not guided about how to manage risks to people’s health and well-being and how to support people to meet their needs in their preferred manner. Where people had been identified as at risk of not eating or drinking enough to maintain their health, the records used to monitor their well-being had not been consistently completed. It was therefore not possible to ascertain if people’s nutritional and hydration needs were being met. The manager recognised the care plans required improvement and this was an area where they were receiving advice and guidance from the local authority’s quality assurance and improvement team (QAIT).

People told us they felt safe at the home. One person said “Yes I do. People here know what they’re doing.” Relatives told us they had no concerns for people’s safety and were confident people were being cared for well. Prior to the inspection it had been identified by the local authority that the home had been slow in reporting a potential safeguarding matter to them. As a result the home had agreed to work with QAIT to reviews its management practices. Staff told us they had received training in safeguarding adults and were aware of their responsibilities should they feel people were at risk of abuse.

Staff said they respected people’s rights to make decisions about their care and care plans guided staff to seek consent before assisting people. The home had undertaken some assessments of people’s capacity to consent to care and support where specific decisions needed to be made, such as the use of bedrails to keep people safe. However, this was not seen in all of the care plans we looked at where decisions were required to be made. A number of people were unsafe to leave the home unsupervised due to living with dementia. The home used a coded lock on the front door to ensure their safety. However, authorisation to restrict people’s liberty in this way had not been sought.

During our inspection we observed people receiving their medicines. We saw more than one person’s medicines being dispensed at the same time and the medicine administration records were signed prior to people receiving their medicines. This placed people at risk of receiving the wrong medicine and also medicines were signed for as given when they may not have been taken. The manager told us this practice would cease immediately.

People and relatives spoke positively about the staff and praised them for their kindness. People’s comments included, “They listen to me and they’re always polite. I can’t fault them, I’m happy” and “I couldn’t be happier. Everyone is so kind.” A relative told us the home had come highly recommended to them and that was why they had chosen the home for their relation. They said they would recommend the home to others as well. Staff treated people with respect and kindness. People told us there was sufficient staff on duty to meet their needs. One person said, “If I need anything I ring my bell and they come. Staff are always on hand.”

People said they enjoyed the food. One person said “I’m pleased with the food, there’s plenty of it, and there’s a good choice.” Throughout the inspection we saw people being offered drinks and snacks and staff responded to people’s requests for a drink promptly.

Staff told us they received the training they needed to understand and meet people’s needs. The manager told us they had commenced a programme of training updates for staff. Staff told us they felt well supported by the manager and the nursing staff. They said the manager spoke to them every day about what was happening in the home and their future plans for improvement. One said, “We’re a great team” and another said, “I love my job.”

People's general health was monitored and they were referred to doctors and other healthcare

professionals when required. People told us they could ask to see their GP at any time and the nurses would arrange this upon their request. A visiting healthcare professional told us they were confident the staff supported people well. They said staff were prompt to seek advice and kept them fully informed of people’s needs.

People told us they felt comfortable raising concerns and they said the manager was approachable and available to talk to. They said they would speak to the manager or the staff if they were unhappy about anything. One person said, “I don’t know why I would complain. Everything’s fine.”

The manager had recently sent written surveys to people and their families to gain their views about the quality of the care and support provided in the home. Once these surveys had been returned, the manager confirmed any suggestions for improvements would be acted upon. They had also commenced a regular meeting once a month for people and their relatives to enjoy ‘high tea’ with them and to share their views. They held regular staff meetings and clinical governance meetings with the nurses to share information and discuss improvements within the home. The manager demonstrated a commitment to make the necessary improvements to the home and for the home to be considered a good place to live and to receive care. Staff told us the aims and values of the home were discussed with them and they described them as ensuring people received “high quality care”. They said they worked well together as a team to ensure this happened.

We made three recommendations to the home to improve the monitoring of people’s food and fluid intake for those at risk of not eating and drinking enough to maintain their health, to document people’s involvement in their care planning and to assess people’s capacity to make decisions about their care where necessary. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to care planning, staff recruitment practices and the management of the home, including managing risks to people’s safety.

You can see what action we told the provider to take at the back of the full version of the report.