Archived: Kingsley Cottage

About the service

Kingsley Cottage is a residential care home providing personal care for up to 17 people aged 65 and over. At the time of our inspection, there was 17 people living at the home, some of whom were living with dementia.

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

Audits and quality monitoring were in place, but the recording of actions taken was not always clear; for example, on the outcome of actions taken to reduce accidents and incidents.

People were administered their medicines as prescribed. People’s needs and risks were assessed with management plans in place to reduce the risk of harm. Staff knew people well including their likes, dislikes, risks to them and how to minimise them. There were enough staff to meet people’s needs safely. Staff were recruited safely to ensure they were safe to work with vulnerable people. Staff and visitors wore personal protective equipment (PPE) in line with government guidance to reduce the spread of infection within the home.

Relatives told us they were kept up to date and informed and felt their family member were safe and well cared for. Feedback was sought from people and relatives. Staff gave mixed views on whether they had regular supervision. The service worked well with other professionals to ensure people’s needs were met safely and efficiently.

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 24 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for five out of six inspections, with one being rated as inadequate.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. We are currently gathering and reviewing evidence in relation to this. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of falls. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

At the previous inspection on 29 November 2019. 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 and good governance.

During this focused inspection we checked they had followed their action plan and confirmed if they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 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.

We have found evidence that the provider needs to make improvement. 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.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside and meet with 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.

We found the following examples of good practice.

Staff explained self-isolation to people in a person centred way. This supported people to understand the process and reassured those that had feelings of anxiety.

Staff were wearing personal protective equipment (PPE) in line with guidance and were knowledgeable about what PPE they needed for different tasks.

Furniture had been rearranged to support social distancing and communal areas were deep cleaned whilst people were self-isolating. The provider had sourced additional cleaning supplies such as chlorine tablets to maintain the cleanliness of the home.

Travel was provided for staff who normally used public transport to travel to and from the home. This lowered the contact staff had with others before and after supporting people.

The home had implemented a COVID-19 folder where policies, guidance and individual risk assessments for people were located. This meant that information about infection control and people’s needs was easily accessible for staff.

Further information is in the detailed findings below.

Kingsley Cottage is a care home that is registered to provide care and accommodation to a maximum of 17 older people including people with a diagnosis of dementia. At the time of the inspection there were 17 people living at the home, most of whom were live with dementia.

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

Care files had been reviewed but not updated to reflect people’s current needs. Care files didn’t always contain moving and handling risk assessments for people that required these.

The service did not have sufficient processes in place to manage the stock levels of people’s medicines. Audits were ineffective and did not highlight any errors.

Audits were undertaken to look at incidents, but none were completed to look and learn from accidents. The service could not always evidence they had worked in line with the Duty of Candour.

People had end of life care plans. However, information in these was limited, and did not evidence clearly how people wished to be supported.

We made a recommendation regarding evidencing people’s end of life wishes

Staff were appropriately trained. The training matrix illustrated that staff had completed the provider mandatory training in a timely manner. Staff received supervision.

People’s assessments were person-centred and considered all aspects of their lives.

People were supported in a caring and compassionate manner. Staff told us how much they enjoyed supporting people at Kingsley Cottage.

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.

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 December 2018). The service remains rated requires improvement. This service has been rated requires improvement for four out of the last five inspections, where one inspection was inadequate.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Enforcement

We have identified two breaches at this inspection. Regulation 12, the registered person failed to ensure risks relating to the safety, health and welfare of people using the service were assessed and managed safely. Regulation 17, the registered person had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.

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

Follow up

We will request an action plan for 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.

As the service was rated ‘Inadequate’ we placed the service in special measures. We asked the provider to send us an action plan each month of how they were meeting the regulations. We placed two conditions on the provider’s registration, telling the provider that they must send us documentary evidence to show that immediate action had been taken to cover all radiators and all exposed hot water pipes at Kingsley Cottage. In addition, we said the provider must send us documentary evidence to show that immediate action had been taken to prevent service users, visitors or unauthorized staff from accessing the first-floor boiler room.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvements are made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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 and is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

We inspected this service again on the 5 and 7 November 2018. The inspection was unannounced on the first day. On the second day of the inspection the provider and manager were informed we would return to the home. The inspection was to check on whether the provider had made the necessary improvements.

Kingsley Cottage is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kingsley Cottage is registered to provide care and accommodation to a maximum of 17 older people including people with a diagnosis of dementia. At the time of the inspection there were 17 people living at the home.

There was an experienced registered manager in post at the time of our inspection. 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.

We found some improvements had been made at the home since our previous inspection. At this inspection we found the provider was meeting the Regulations, and was no longer in breach. However, we continue to rate ‘Safe’ and ‘Well-Led’ as Requires Improvement.

The conditions we placed on the provider’s registration at our inspection in June/July 2018 had been met. All radiators and hot water pipes at the home had been covered, and procedures were in place to prevent people and unauthorised staff from accessing the first-floor boiler room.

At our previous inspection we found the provider and registered manager did not always manage risks to people's safety, and people were placed at unnecessary risk. Care records required improvement to ensure people’s care was delivered in a person-centred way, taking into account their wishes and preferences. In addition, communication techniques needed to be improved to make sure people were supported fully in everyday activities, and their care decisions.

Risk assessment procedures had been improved. Environmental improvements had been made at the home, to make sure people were cared for in a safe place.

Care records had been improved since our previous inspection visit. People were involved in the planning and review of their care. Care records were individual to the person and people’s specific communication needs were being met.

The manager and staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and supported people in accordance with the Act. Staff were aware of who needed support to make decisions about their care and welfare.

Medicines procedures had been changed to ensure medicines were managed safely. Infection control practices had improved and the home was fresh and clean.

There were enough staff to care for people safely. Staff had received updated training to enable them to support people effectively.

People had access to sufficient amounts of food to maintain their health and weight. Action was taken to refer people to health professionals when needed, to gain treatment when their health needs changed.

Staff were available to take care of people's immediate care needs, and had time to spend with people.

People were treated with dignity and were consistently given choices in their daily lives. There were stimulating activities on offer to people, to engage them in hobbies, interests and events that might increase their wellbeing.

The provider had taken action to improve the service and had acted on the concerns raised in previous inspections. However, improvements needed to be sustained and built upon to ensure people always received good quality care that met their needs.

During this inspection the provider demonstrated to us that improvements had been made and is no longer rated as ‘Inadequate’ overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Kingsley Cottage accommodates up to 17 people with bedrooms on the ground floor and first floor, which is accessible by a lift and stairway. At this inspection 17 people were living there.

Kingsley Cottage had a registered manager in post who was present during day one of this inspection’s site visit but was not available on day two due to pre-planned annual leave. The registered provider was available and present during day two. 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.

Following our last inspection we published our report in November 2017. At that inspection we identified areas of improvement that needed to be made. These were in relation to the key questions, Effective, it was not evident how decisions were made with people, Responsive, people had differing experiences regarding social activities, and Well Led, the provider needed to embed their quality monitoring processes to ensure people received a “Good” service.

At this inspection we identified that improvements had been made regarding people’s activities and social interactions. However, we found serious concerns regarding people’s safety, care planning and medicines and improvements relating to decision making and quality monitoring were still needed.

In total, during this inspection, we identified four breaches of regulations. These were in relation to, unsafe care and treatment of people, people not having personalised care, ineffective quality assurance systems to identify improvements and the requirement to display the rating of the latest inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The provider and management team did not fully understand their requirements of registration with the Care Quality Commission in meeting the associated regulations. The provider and management team had been unable to achieve an overall “good” since March 2016 when we first inspected them using our current methodology. This is their fourth consecutive inspection where improvements have been required. They have repeatedly failed to act on areas of concern previously identified to them.

People were not safe as the provider failed to act on known areas of risk associated with the environment within which they lived. The provider had not embedded effective infection prevention and control practices. People did not always receive their medicines as prescribed.

It was not evident how decisions affecting people’s care and support were made. The provider had not embedded the principles of the Mental Capacity Act 2005 into the assessment of people’s needs putting their human rights at risk of abuse. People received assistance with food and fluids to maintain their well-being. When needed people had the assistance of community based healthcare professionals.

The provider could not assure us that people were involved in the decision-making process in relation to their care and support. People’s protected characteristics, such as disability and sexuality, were not explored or promoted by the management team as part of their assessment process.

People were not involved in the development of their care and support plans. Care and support plans did not accurately and robustly reflect people’s current care needs. There were no end of life care plans for people.

People took part in activities they found enjoyable and stimulating. People and relatives found the provider and management team approachable and interactive. People and relatives felt able to raise any concerns with the registered manager or the provider and were confident that they would be listened too. There were enough staff to meet people’s needs and the provider followed safe recruitment practices. People received care and support from a compassionate and caring staff team. Families and friends felt welcome and could visit whenever they wanted.

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

We carried out an unannounced inspection visit on 18 September 2017. Our inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of providing care or support for people.

We had previously inspected the home on 7 February 2017 and rated the home as ‘Requires improvement’ overall and inadequate within our question ‘Is this service well led?’ Our rating reflected our concerns with the safety of the home’s environment; how the staff supported people who needed help with decision making and the effectiveness of the systems used to monitor and improve the quality and safety of the service. We received an action plan from the provider which said the improvements would be made by July 2017. At this inspection we found the provider had made the improvements they told us they would make, although further improvements were needed.

People had mixed views about how they were supported to be involved with activities related to their hobbies and interests and people spent time unoccupied. When people lacked capacity to make decisions for themselves, capacity assessments had been completed however, these were not always specific to the decision being made. Further work was needed when decisions were made in people’s best interests.

Staff were available at the times people needed them and had received training so that people’s care and support needs were met. Staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible.

People were involved in decisions about their care and told us that they received support in the ways they preferred. People were supported to maintain relationships with people important to them and visitors were welcomed at the home.

People were dressed in their own style and if they needed support, staff helped people to take a pride in their appearance. The staff understood how people wanted to be supported and ensured people’s privacy and dignity.

People had a choice of food, and were encouraged to have enough to drink. People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. Medicines were managed so that people received their medication as prescribed.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home. People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to complaints. People were happy with the service provided and how staff provided their support.

This inspection took place on 7 February 2017 and was unannounced.

Kingsley Cottage provides accommodation for up to 17 people who require accommodation and or personal care. On the day of our inspection visit, there were 17 people living at the home, some of who were living with dementia.

We had previously inspected the home on 24 March 2016 and rated the home as requires improvement overall with specific concerns about the safety of the home’s environment, how the staff supported people who needed help with decision making and the effectiveness of the systems used to assess, monitor and improve the quality and safety of the service. We received an action plan from the provider which said the improvements would be made by July 2016. At this inspection we found the provider had not made all of the improvements they told us they would make. We also found improvements were needed in other areas including the administration and management of people’s medicines and the risks associated with people’s care.

We saw that some improvements had been made to the home’s environment but we identified ongoing concerns regarding the management of the service. There was a lack of effective governance and managerial oversight of the service. Steps to ensure the health and safety of people and others were not always considered and risk assessments had not been developed for all areas of identified risk. The registered manager had introduced audits for medicines, but these had not been effective in identifying the concerns we found with the storage and administration of medicines.

Risks associated with people’s care had been assessed but management plans were not always followed to ensure any identified risks were minimised. People felt safe at the home and sufficient numbers of suitably recruited staff were available to meet people's needs. Staff understood their responsibilities to keep people safe from the risk of abuse. Staff received training and support to meet people’s needs and felt supported by the registered manager.

Further improvements were required to ensure the provider and registered manager consistently followed the requirements of the Mental Capacity Act 2005 where people were unable to make certain decisions for themselves. Staff sought people’s consent and encouraged people to make choices about their daily routine to promote their independence. People accessed the support of other health professionals when needed.

Staff treated people in a kind and compassionate manner but at times, they did not always treat people with dignity and respect. People were not always supported to have an enjoyable mealtime experience and some people’s individual needs were not met.

People were not always offered opportunities to join in social activities and follow their hobbies and interests. People were encouraged to maintain important relationships and visitors were made welcome.

People knew how to raise any concerns and complaints and were kept informed about things that were happening in the service. However, the provider did not routinely seek people’s views on how the service could be improved.

The provider was not meeting some of the requirements of their registration with us. They had not displayed their performance rating as required and had failed to notify us about a safeguarding concern referred to the local safeguarding team.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Kingsley Cottage is registered to provide accommodation and or personal care for up to 17 people, some of whom were living with dementia. On the day of our inspection, the home was full.

There was a registered manager in post who had registered in 2002. 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.

The provider worked alongside the registered manager at the service. There were no clear arrangements in place to determine who had overall responsibility for ensuring effective systems to assess, monitor and drive improvement in the quality and safety of the service. The home’s environment was not well maintained and potential risks to people’s safety were not being identified and managed. People received their medicines when they needed them but improvements were required to ensure medicines were stored, recorded and managed safely.

The registered manager and staff were not working within the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff sought people’s consent before providing care but people’s capacity to make their own decisions was not assessed when needed. Some people were being deprived of their liberty to keep them safe but applications had not been made to ensure this was formally and legally agreed to be in their best interests.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team. Risks to people’s health and wellbeing were assessed and managed. There were sufficient suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff were kind and caring, promoted people’s privacy and dignity and encouraged them to maintain their independence. People were supported and encouraged to eat and drink enough to maintain a healthy diet. People were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

There was a positive atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. Staff felt supported by the registered manager and provider and were encouraged to give their views on the service to improve people’s experience of care.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

At our previous inspection in November 2012 we had concerns that the staffing levels were not sufficient to meet the needs of the people who used the service, staff did not feel supported and did not have adequate knowledge in safeguarding procedures. We were supported throughout the inspection by the manager and the provider. At this inspection we found that improvements had been made in all these areas.

We looked to see if people who used the service consented to their care, treatment and support. We found that people were consulted with as much as they were able to be and were involved in their care planning.

We found that Kingsley Cottage had a complaints procedure and people who used the service and their relatives knew how to make a complaint and who to complain to.

We saw that peoples' care and welfare needs were being met; people who used the service and their relatives told us that they were happy with the care they received. One person told us: 'It's like a five star hotel here'.

People who used the service told us they liked living at Kingsley Cottage and the staff were all kind. We saw that staff treated people with dignity and respect throughout the day.

Staff we spoke with told us they were happy at Kingsley Cottage but they felt they needed more support in areas of their personal development.

Although staff had received training in safeguarding all the staff we spoke with were unable to tell us the safeguarding procedure and when it might be implemented.

We had concerns over the staffing levels at Kingsley Cottage and we asked the provider on the day of the inspection to increase the levels to meet the needs of the people that used the service.

The service had implemented limited quality monitoring systems to ensure good quality care was being delivered.