The inspection took place on 7 and 10 December 2018 and the first day was unannounced. At the last inspection in April 2016 the home was rated as good in key questions 'Safe', 'Effective', 'Caring' and 'Well Led'. The home was rated requires improvement in 'Responsive'. At this inspection, we found that the key questions 'Responsive' had improved to good but the key questions of ‘Safe’ and ‘Well Led’ were now rated as Requires Improvement.Kingsmount Residential Home 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. Kingsmount Residential Home is registered to provide care, nursing and accommodation to a maximum of 32 older people, some of whom may be living with dementia or memory loss. At the time of the inspection, there were 31 people living at the home.
At the time of the inspection there was no registered manager in post. The provider had employed a new manager who had started at the home two days prior to the inspection. The new manager was an experienced care home manager and they told us they would be submitting an application with the Care Quality Commission to become the registered manager of the home. The new manger was supported during this inspection by the deputy manager and the nominated individual. The report refers to them as ‘the management team’.
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.
Risks to people were assessed and risk assessments tools were used to identify common risks such as those relating to falls, skin integrity and medication. However, daily monitoring records did not always show that care was being delivered as it should. Equipment used to minimise risk was not always set correctly in order to reduce the risk of skin damage.
Where people were at risk of dehydration, fluid monitoring charts did not indicate if action had been taken or guidance sought when a person had consistently not reached their target intake amount.
Improvements were required to ensure that medicines were managed safely. Whilst medicines were stored and administered safely, random sampling of five medicines found discrepancies with the stock levels of three medicines. Other aspects of medicines were managed safely
Systems and processes in place to monitor the quality and safety of the home failed to identify and address the issues we found during this inspection.
People told us staff supported them with kindness and respect. Comments included, “They are very caring here”, “Staff are on hand and we can call them anytime, they have been as good as gold” and “They’ve always been kind to me, it feels safe here.” Staff respected people's privacy and dignity and interacted with people in a caring, compassionate and professional manner. People were encouraged to be as independent as possible but where additional support was needed this was provided.
People told us they felt safe when they received care and support from staff at the home. One person told us, “It’s very clean here, and safe.” A relative said, “I sleep at night because they look after mum so well.” People were protected from the risk of abuse because staff understood how to identify possible abuse and were clear in how they would report this. Staff told us they had received safeguarding training.
People were supported by staff that had been recruited safely and had sufficient knowledge and skills to enable them to care for people. There was a comprehensive staff training programme in place and staff told us they felt supported and received regular supervision. However, during the inspection we saw three recently completed appraisal forms were identical and not individualised for the staff members. We made a recommendation to the provider about ensuring appraisals were tailored to the individual staff member.
People and their relatives gave us a mixed response about there being enough staff. One person told us, “The girls don’t really have time to speak to me sometimes, it’s time that does it as they’re so short staffed.” Another person told us, “I use the call bell they don't take very long to come.” Staffing rota's and observations during the inspection showed us there were sufficient numbers of staff to meet people's needs.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the home supported this practice. Where people lacked capacity to make specific decisions about their care and treatment, decisions had been made in their best interests. However, one person, who had been assessed as not having the capacity to decide about taking their medicines or the use of a sensor alarm mat placed in their room to keep them safe, did not have a best interests decision recorded in their records. This was addressed immediately. We made a recommendation to the provider to ensure that all assessments and best interests decisions are made in compliance with the Mental Capacity Act 2005.
People received support that was tailored to them as individuals and were supported by staff who understood their specific needs and how to support them in the way they wanted to receive care. People's records were comprehensive enough to give staff a good understanding of people's preferences and life experiences. This helped staff to support people to engage in meaningful activities that they enjoyed. Since the last inspection the home had worked very hard to improve the provision of one to one engagement and activities to reduce the risk of social isolation.
People living at the home, relatives and staff were happy with how the home was being managed. They found the management team and staff approachable. The provider regularly sought feedback from people living at the home and their relatives about the support provided. We saw evidence that the feedback received was used to develop and improve the service.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.