Kingsley House Residential Care Home

Kingsley House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kingsley House provides accommodation and personal care for up to 3 older people who were living with the experience of dementia. There were 3 people living at the service at the time of our inspection.

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

The provider did not always effectively operate quality assurance systems to oversee the quality and safety of the service. These systems had not identified shortfalls in the quality and safety of the service or ensured that expected standards were met.

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. Staffing levels did not support activities and people using the service did not always have access to activities inside and outside of the home.

The provider did not ensure consistent actions were taken to reduce risks to people and plans were not in place to minimise those risks. Staff were not appropriately supported in their role and they did not receive regular supervisions; spot checks and team meetings were infrequent.

There were infection prevention and control policies in place, however the provider did not always follow these. We found that the environment was not designed in line with best practice guidance for supporting people with dementia and we have made a recommendation about this.

Safe recruitment procedures were followed. Staff knew how to respond to possible safeguarding concerns. The staff were happy working at the service they knew people well.

The individual who was also the manager owned the care home. They worked with staff providing support for people using the service. They had a good knowledge of the individual needs of the people who were living there and had good relationships with them and the staff. People using the service and staff told us they felt managers were approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 17 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led. 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 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 Kingsley House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We identified breaches in relation to safe care and treatment, good governance, staffing and need for consent. We have also made 3 recommendations for the provider to review best practice guidance to promote person centred care; supporting and involving people to maintain a balanced diet and follow best practice and guidance for providing an environment which meet people’s needs.

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.

Kingsley House 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 House provides accommodation and personal care for up to three older people who were living with the experience of dementia. There were three people living at the service at the time of our inspection.

The provider is not required to have a registered manager in place because they are registered as an individual. The provider runs and manages the service.

People were consulted about day to day decisions and staff had received training on the Mental Capacity Act 2005 so they knew that they needed to ask people for their consent before delivering care. However, people’s capacity to make decisions about their care and treatment was not always assessed and recorded. Processes had been followed to ensure that, when necessary, people were deprived of their liberty lawfully.

Risks to people's wellbeing and safety had been assessed, and where risks had been identified, the provider had taken appropriate action to mitigate these.

The provider had sought relevant guidance and had taken steps to improve the environment to meet the needs of people living with the experience of dementia.

Staff provided a range of activities to people using the service. The provider had purchased new activity material and staff consulted people about what they wanted to do.

People were supported by staff who received regular training and who were regularly supervised and appraised.

The provider told us they ensured that lessons were learned when things went wrong. Although there had been no incidents and accidents since our last inspection, they told us they would ensure that incident reports would include an analysis or actions needed to minimise the risk of reoccurrence.

We saw that staff supported people in a kind and caring way and interacted with them throughout the day. People were supported with their individual needs in a way that valued their diversity, values and human rights.

The provider had a number of systems to monitor the quality of the service and put action plans in place where concerns were identified. There were arrangements in place to protect people from the risk of infection and the environment was clean and free of hazards.

People's needs were assessed prior to receiving a service and care plans were developed from the assessments. Care plans were comprehensive and contained details of people’s background and care needs.

There were procedures for safeguarding adults and staff were aware of these. Staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

Staff followed the procedure for recording and the safe administration of medicines.

The provider employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff absence. Recruitment checks were in place to obtain information about new staff and ensure they were suitable before they started working for the service.

People's health and nutritional needs had been assessed, recorded and were being monitored. People had access to healthcare professionals as they needed, and their visits were recorded in people’s care plans. People’s end of life wishes were recorded and respected.

The provider sought guidance and support from other healthcare professionals and attended workshops and provider forums in order to keep abreast of developments within the social care sector and shared important information with staff.

There was a complaints procedure in place which the provider followed. However, no complaints had been received in the last year.

Staff told us that the provider was approachable and supportive and encouraged an open and transparent culture within the service. There were regular staff meetings where relevant issues were raised.

Kingsley House 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 House provides accommodation and personal care for up to three older people, some of whom were living with the experience of dementia. There were three people living at the service at the time of our inspection, although one person was in hospital.

The provider is not required to have a registered manager in place because they are registered as an individual. The provider runs and manages the service.

Not all the risks to people's wellbeing and safety had been assessed, and where risks had been identified, the provider had not always taken appropriate action to mitigate these.

The environment was not designed in a way to support people who were living with the experience of dementia.

There were few organised activities and these were not always person-centred and did not always meet the needs of people living with dementia.

Staff received training, although the training matrix had not been updated and training certificates were not always available. The provider was able to provide evidence of training after the inspection.

The provider did not always ensure that lessons were learned when things went wrong. Incident and accident forms did not include an analysis or actions needed to minimise the risk of reoccurrence.

Although staff supported people in a kind and caring way, they rarely interacted with people apart from asking them what they wanted to eat or drink.

People were not always supported with their individual needs in a way that valued their diversity, values and human rights.

The provider had a number of systems to monitor the quality of the service and put action plans in place where concerns were identified. However, audits had failed to identify the issues we found.

There were systems in place to protect people from the risk of infection and the environment was clean and free of hazards.

People's needs were assessed prior to receiving a service and care plans were developed from the assessments. Care plans were comprehensive and contained details of people’s background and care needs.

There were procedures for safeguarding adults and staff were aware of these. Staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

Staff followed the procedure for recording and the safe administration of medicines.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff absence. Recruitment checks were in place to obtain information about new staff and ensure they were suitable before they started working for the service.

The provider was aware of their responsibilities in line with the requirements of the Mental Capacity Act 2005 (MCA) and staff had received training on this. People’s capacity to make decisions about their care and treatment had been assessed. Processes had been followed to ensure that, when necessary, people were deprived of their liberty lawfully. However, we did observe an incident where a practice was being used to restrict the liberty of a person without proper processes being in place to help safeguard the right of the person.

People's health and nutritional needs had been assessed, recorded and were being monitored. People had access to healthcare professionals as they needed, and their visits were recorded in people’s care plans. People’s end of life wishes were recorded and respected.

Staff received supervision and appraisals. The provider sought guidance and support from other healthcare professionals and attended workshops and provider forums in order to keep abreast of developments within the social care sector and shared important information with staff.

There was a complaints procedure in place which the provider followed. However no complaints had been received in the last year.

Staff told us that the provider was approachable and supportive and encouraged an open and transparent culture within the service. They said that people and staff were supported to raise concerns and make suggestions about where improvements could be made.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to Safe Care and Treatment, Dignity and respect, Safeguarding service users from abuse and improper treatment, Person-Centred care and Good Governance. You can see what actions we told the provider to take at the back of the full version of this report. We also made a recommendation in relation to the environment.

Kingsley House provides accommodation and personal care for up to three older people. There were two people using the service at the time of our inspection.

The provider is not required to have a registered manager in place and the provider runs and manages the service.

There were systems and processes in place to protect people from the risk of harm. There were enough staff on duty to meet people’s needs and staff within the organisation were available to cover in the event of staff shortage to ensure people’s safety.

Staff had undertaken training in the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). People were given choices and the opportunities to make decisions. Care records confirmed this.

There were arrangements in place for the management of people’s medicines and staff had received training in the administration of medicines. The provider carried out audits of the prescribed medicines and records showed that they were regular.

People had access to a range of health professionals to help maintain their health.People’s nutritional needs were met, and their menus were devised taking into account people’s preferences and healthcare needs.

Staff received effective training, supervision and appraisal. The provider sought guidance and support from other healthcare professionals and attended workshops and conferences in order to cascade important information to staff, thus ensuring that the staff team were well informed and trained to deliver effective support to people.

Staff were caring and treated people with dignity and respect. Care plans were clear and comprehensive and written in a way to address each person’s individual needs, including what was important to them, and how they wanted their care to be provided.

A range of activities were provided according to people’s preferences and abilities. We saw that people were cared for in a way that took account of their diversity, values and human rights. The provider had started to develop the environment to meet the needs of people living with dementia.

People, staff and stakeholders told us the provider and staff were supportive and professional. The provider told us they encouraged an open and transparent culture within the service. The service supported people and their relatives to raise concerns and used feedback to make improvements where needed.

The provider had effective systems in place to monitor the quality of the service and ensured that areas for improvements were identified and addressed.

We gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with three people who used the service, three staff supporting them including the registered manager. We also looked at a selection of records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People received care in an environment that was safe. The communal areas and bedrooms we looked at were clean and tidy. People were able to move about freely in the home supported by a staff member on duty. We saw rooms were personalised with photographs. One person told us'I am happy here, I don't want for anything.'

Staff training records we looked at showed people had the skills and experience needed to support people living in the home. The registered manager told us they visited the home at least twice daily and were available on call in case of emergencies. The provider was also able to arrange staff to cover from their other home when this was required.

We found that although appropriate arrangements had been made for the obtaining, safe keeping and disposal of medicines, the provider had not always ensured people who used the service were receiving all of their prescribed medicines in a safe way because they failed to maintain accurate records of what medicines had been given to them.

There were procedures in place to identify and prevent abuse to people occurring. Referral procedures to external agencies were in place and staff we spoke with were aware of whom to contact, both internally and externally, should they suspect someone had been the victim of abuse.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. On the day of our inspection we were advised no DoLS applications had been made. Relevant staff understood when an application should be made to deprive someone of their liberty.

We spoke with three people who used the service. They all told us they could speak to staff if they had any worries or concerns. One person told us 'I feel protected, it's ok here.' Another person told us 'Yes, I am happy here, the staff are very nice.'

Is the service effective?

People's needs were assessed and care was delivered in line with their individual care plans. We looked at three care plans and saw people had risk assessments in place for staff to follow. This ensured people were supported appropriately with their physical and mental health well-being.

Care plans we looked at included assessments and reviews of people's health and care needs. There was information included to ensure staff delivered appropriate care to meet people's needs. All care staff we observed demonstrated they knew people who used the service well and understood how best to support them.

We reviewed two staff training files and saw that training identified as mandatory by the provider such as safeguarding, moving and handling, first aid, infection control, food hygiene and fire safety was up to date. The registered manager kept a training matrix so they could keep a log of what training staff were due to receive. Further training was scheduled to take place by the end of 2014 which included medicines administration, respect and dignity in personal care, falls risk and first aid.

Is the service caring?

We observed staff interacting with people at different times during the day and saw lunch being served. We noticed at lunch time that people were given time to enjoy their meal. One person told us, 'The food is very good here.' Another person told after they had finished their lunch 'I really enjoyed that.'

We found during our inspection that people were supported by staff who displayed a calm demeanour, patience and kindness towards them. The general atmosphere was relaxed and staff had a good rapport with people using the service. One person who used the service (referring to the staff) told us 'They are very obliging, very kind and respectful.'

Is the service responsive?

The provider had in place measures to assess people before they moved into the home to ensure they could meet their needs. This ensured the risk to a breakdown in the placement was minimised. We saw that people's health and social care needs were reviewed frequently with other professionals.

People were confident they would receive the support they needed quickly should their health needs change. This was demonstrated by the registered manager and staff member on duty who were able to recognise changes in one person's physical health needs. This had been documented and monitored closely with medical help arranged to ensure their wellbeing.

Is the service well led?

The registered manager was a health care professional with over 40 years' experience in general nursing. We spoke with the registered manager who showed a good understanding of what was required to ensure staff were supported in their day to day work.

We saw decisions about care and treatment were made by the appropriate staff at the appropriate level. This meant there were systems in place to monitor, assess and manage the risks to the health, safety and welfare of people who used the service and others.

We spoke with one person using the service who told us 'I live here, it's very good.' A relative of another person told us 'we are very happy with the home, they look after my [relative] very well.' We also spoke with the provider and a member of staff.

We saw people's care plans were reviewed monthly and a record was kept of the care and support they received. However, people's care needs assessments were not updated and included information for staff that the provider told us was no longer relevant.

While a record was kept of people's daily care, there was a need to include more detail in the event of accidents or incidents involving people using the service.

While there was only one member of staff on duty in the home from 8 am ' 8 pm, the provider had arrangements in place to provide additional staff from another service when people needed extra support.

The provider had information that was available for people who may choose to use the service but this needed to be updated. We saw that staff treated people with respect and offered them some choices about their care.

Care was not always delivered in line with people's care plans. Only one member of staff was working when we visited the home and they were unable to support and provide personal care safely to people using the service as well as completing their other duties, including cleaning and cooking.

The service provided good standards of private and communal accommodation. People's bedrooms were individual and there was sufficient communal space.

The provider carried out checks to make sure that appropriate staff were recruited to work in the service.

The provider had systems in place to monitor the quality of service provision.

We looked at the care plans for all three people using the service. We saw that the plans addressed all areas of each person's health and social care needs. The plans also included appropriate risk assessments and guidance for staff on how identified risks should be managed.

Care records showed that staff supported people to be independent and to make decisions for themselves, where possible. We saw that the relatives of one person using the service were kept informed of significant events.