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Archived: Kingsacre Care Home Requires improvement

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Reports


Inspection carried out on 9 February 2017

During a routine inspection

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 no

Inspection carried out on 18 November 2014

During a routine inspection

Kingsacre Care Home is a nursing and residential care home which predominately provides nursing and personal care to adults. The home is registered to accommodate up to a maximum of 34 people. On the day of the inspection 31 people were living at Kingsacre Care Home. Some of the people at the time of our visit had physical health needs and some mental frailty due to a diagnosis of dementia.

The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. 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.

We carried out this unannounced inspection of Kingsacre Care Home on 18 November 2014. We had received anonymous concerns about how people were generally being cared for, people did not have choices in their daily lives and how people who had mobility difficulties were supported around the home. At this visit we undertook a full inspection which included looking at the anonymous concerns raised. Our findings were that people were being cared for by competent and experienced staff, people had choices in their daily lives and that their mobility was supported appropriately.

People felt safe living in the home and relatives told us they thought people were safe. A relative told us they felt their family member was cared for safely and that this reassurance had allowed them “the opportunity to go away for the first time in many years on a holiday.” Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

People told us staff were; “kind,” “caring,” “marvellous”and “they really look after me well, I can’t be at my own home but this is now my home.” They told us they were completely satisfied with the care provided and the manner in which it was given. Relatives told us they found staff to have; “great skill” and were “competent and professional”. Visiting professionals told us; “the care is to a very good standard”, “staff are very caring, they listen to advice and take it on board.

”Staff had attended appropriate training to ensure that their skills and knowledge, for example in the area of moving and handling, safeguarding and dementia care was up to date. We found that there were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs.

People’s care and health needs were assessed prior to admission to the home. Staff ensured they found out as much information about the person so that they could;“really get to know them, their likes, dislikes, interests they wanted to know all about their life.” Relatives felt this gave staff a better understanding of their family member and how they could care for them. People chose how to spend their day and a range of activities were provided.Visitors told us they were always made welcome and were able to visit at any time.

People were supported with their medicines in a safe way by staff that had been appropriately trained. However,clearer guidance in how the person wished to receive their medicines would ensure people had a choice in how their medicine was administered to them.

The manager and staff had a general understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. The provider agreed to extend this training to incorporate the recent legislative changes. Where people did not have the capacity to make certain decisions the home involved family and relevant professionals to ensure decisions were made in the person’s best interests.

Staff told us they were supported by managers. They attended regular meetings (called supervision) with their line managers. This allowed staff the opportunity to discuss how they provided support to people, to ensure they met people’s needs and time to review their aims,objectives and any professional development plans. Staff also had an annual appraisal to review their work performance over the year.

People’s care plans, identified the person’s care and health needs and how the person wished to be supported. They were written in a manner that informed,guided and directed staff in how to approach and care fora person’s physical and emotional needs. Records showed staff had made referrals to relevant healthcare services quickly when changes to people’s health or wellbeing had been identified. Staff felt the care plans allowed a consistent approach when providing care so the person received effective care from all staff. Relatives told us they were invited and attended care plan review meetings and found these meetings beneficial.

People told us staff were very caring and looked after them well. Visitors told us; “Staff are lovely.” We saw staff provided care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the home they spoke about them in a caring and compassionate manner. Staff demonstrated a good knowledge of the people they supported.

Peoples' privacy, dignity and independence were respected by staff. At this visit we spent a minimum of five hours, undertaking direct observations using the SOFI tool to see how people were cared for by staff. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw examples of kindness, patience and empathy from staff to people who lived at the home.

We saw the home’s complaints procedure which provided people with information on how to make a complaint.The policy outlined the timescales within which complaints would be acknowledged, investigated and responded to. It also included contact details for the Care Quality Commission, the local social services department, the police and the ombudsman so people were able to take their grievance further if they wished.Records showed the home had not received any complaints in the last year. Relatives told us they had; “No cause to make any complaints” and if they had any issues they felt able to address them with the management team.There was a management structure in the home which provided clear lines of responsibility and accountability.There was a clear ethos at the home which was clear to all staff. It was very important to all the staff and management at the home that people who lived there were supported to be as independent as possible and live their life as they chose. The provider had an effective system to regularly assess and monitor the quality of service that people received.

Inspection carried out on 21 January 2014

During a routine inspection

In this report the registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We asked staff how they were confident people were consenting to the care they offered. One care assistant said “I ask them, most people are able to tell us; we get to know people and we ask in different ways and try different approaches”.

We spoke to people that live at Kingsacre and on person told us the staff are “very good to us, they look after me well. We have good food and a good choice. I am treated respectfully. I am happy with things here”. Another person said “It is very good, staff look after me very well; they treat me respectfully. Staff listen to me and take notice of what I say. I hope I am as good to them as they are to me”.

During our inspection we saw medicines being administered by a qualified nurse. We observed that they explained to the person what the medicine was and what it was for and checked the person had taken it.

All of the staff we spoke with told us that they felt well supported and had good access to training. One care assistant said “we are definitely well supported and the door is always open to talk to the manager. It is a nice atmosphere and a nice team it feels like a family”.

Inspection carried out on 9 October 2012

During a routine inspection

We saw that people’s privacy and dignity were respected and that staff were kind and helpful. Comments from people who used the service included “The staff are wonderful, they are compassionate and respect my privacy”

Records demonstrated that when possible people were involved in the planning of their care and the views of family were considered as part of the homes review process.

We saw staff supporting people in a way that demonstrated they understood their needs and had the skills and training to support them safely and appropriately. One person using the service said “Even when I am being supported by new staff I feel safe”

We saw that people were able to make choices, and choices were respected even when there may be a possible risk. Risks were assessed and guidelines put in place to ensure that any risks to a person’s health, safety and well being were minimised.

Information was available to people about activities taking place in the home. However, records did not demonstrate how activities were decided on and planned or if these were based on individual need.

We saw that staffing levels were sufficient to meet people’s daily personal care needs, however, staff were often busy and did not always have the time to sit and interact with people using the service.

The provider regularly reviews the quality of the service and records demonstrated that changes had been made as a result of feedback.

Reports under our old system of regulation (including those from before CQC was created)