Archived: Prince George Duke of Kent Court

At this inspection we found that improvements had been made in these areas and that the provider was compliant with the relevant regulations. However we also found a further breach of regulations because the systems used to monitor and mitigate risks to people did not always identify areas of risk promptly and because audits of people’s care plans did not always identify issues.

Prince George Duke of Kent Court is a nursing and residential home providing accommodation, care and support for up to 78 people. At the time of our inspection there were 71 people living at the service. There was a 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 that risks to people had been assessed and were safely managed, although improvement was required to ensure there was sufficient guidance for staff on how to manage identified risks. Improvement was also required to the management of people’s records, to ensure they were consistent and could be located promptly when required. People’s medicines were stored and administered safely as prescribed. Staff had received training in safeguarding adults and knew the action to take if they suspected abuse had occurred.

The provider followed safe recruitment practices and there were sufficient staff deployed within the service to meet people’s needs. People had access to a range of healthcare professionals when required and healthcare professionals we spoke with told us staff worked well to meet people’s health needs. People were supported to maintain a balanced diet.

Staff were aware of the importance of seeking consent from the people they supported and the provider followed the requirements of the MCA where people lacked capacity to ensure decisions were made lawfully in people’s best interests. Where required, people were lawfully deprived of the liberty in their best interests under the Deprivation of Liberty Safeguards (DoLS).

People were treated with kindness and consideration and told us they were involved in day to day decisions about their care and treatment. Staff treated people with dignity and respected their privacy. Staff were supported in their roles through training and regular supervision.

People’s care plans were reviewed on a regular basis to ensure they remained reflective of their current needs and views. There was a range of activities available to people at the service. People told us they knew how to complain and any complaints received by the service had been dealt with appropriately in line with the provider’s policy and procedure.

People were able to express their views about the service through regular residents meetings and by completing an annual survey. People told us they felt listened to and that action was taken in response to their feedback. People and staff also spoke positively about the leadership of the service and we saw that an ongoing programme of improvements was in place.

We undertook this unannounced focused inspection of the service on 06 May 2016 to check that the requirements had been met in response to the enforcement action we had taken. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Prince George Duke of Kent Court on our website at www.cqc.org.uk.

Prince George Duke of Kent Court is a nursing and residential home providing accommodation, care and support for up to 78 people. At the time of our inspection there were 72 people living at the home.

There was a 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.

At this inspection we found that action had been taken to address the breaches of regulations 10 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People told us their privacy was respected and this was confirmed by our observations of staff working practice. Records were up to date and reflective of people’s current needs and preferences. Records were also stored securely and staff were able to locate them promptly when requested.

However, we also found a breach of regulations because the registered manager had failed to submit statutory notifications as required by the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

If you want to see the evidence that supports our summary please read the full report.

Is the service Safe?

People living in the home had assessments of possible risks to their health and safety and these were reviewed as and when required.

Staff had the training and knowledge they needed to make sure people living in the home were cared for safely. We saw all communal parts of the home and some people's bedrooms (with their permission) and found the premises and equipment were safe and well maintained.

Is the service effective?

People's care needs were assessed and they told us staff understood their needs and provided the care and support they needed. People were involved in making decisions about their health and personal care wherever possible. If people could not contribute to a specific aspect of their care plan, staff worked with other professionals to assess the care they needed.

Care records we saw showed that some people had not received care in line with their care plan. Most of the care plans and risk assessments we looked at were up to date, had been reviewed and updated monthly, and / or as and when people's needs changed to reflect their current needs. However, some of the care plans we saw were not up to date. The health care records we looked at demonstrated that people had access to external health care professionals' support as required.

Is the service caring?

Each of the care plan files we looked at described the person's likes, dislikes and daily routines.

All the seven people who use the service told us that they felt the care staff were helpful. For example, and one person said care staff were 'very helpful and willing to assist with any requests'. We observed staff maintained an individual's dignity and demonstrated respect whilst providing care and support. However, the provider may wish to note that a person using the service told us, 'I was upset and surprised to have a man come into my room to change my pad.' She had not been asked if she was comfortable with this arrangement and had not been offered any alternative.

Is the service responsive to people's needs?

Most the people we spoke with confirmed staff sought consent before care was provided. Staff we spoke with were able to demonstrate how they would seek consent from a person using the service. We observed staff treated people with respect and involved them in making choices and decisions about their care for example, during mealtimes.

When people did not have the capacity to consent, the provider had acted fully in accordance with legal requirements. However, the provider may wish to note that in some cases there was no evidence of capacity assessments or any best interest decisions. For example, a family gave consent to catheterise a person but there was no capacity assessment or best interest decision in place. There were not enough staff at all times to meet people's needs in a timely manner. Most of the staff we spoke with told us that sometimes they had experienced difficulties in providing timely support to people when required; and said they sometimes struggle with staffing due to the dependency of people who use the services.

Is the service well-led?

All the staff told us they felt supported by their line manager. They also told us they understood their roles and responsibilities.

The provider had effective systems to regularly assess and monitor the quality of service that people received. These included regular audits of medication, care plans, health and safety. There was evidence that learning from these audits took place and appropriate changes were implemented. For example, following these audits, an action plan was developed and implemented to address the issues identified; these included majority of bank staff were booked for mandatory training, staff meeting were held to discuss timely call bell response, mattress replaced when found dirty and care plans were reviewed and updated as and when people's needs had changed. However, the provider may wish to note that two relatives had told us when concerns were raised with management and were listened to but not acted upon. Complaints records we saw showed that at the time of our inspection two complaints investigations were in progress. As the investigations were not completed at the time of our inspection therefore, we were unable to assess the impact of this action.

We found that people were asked for their consent and the provider acted in accordance with their wishes. People's care and support needs were assessed and regularly reviewed. Staff understood people's care needs and knew how to protect them from risk and harm. We saw there were qualified, skilled and experienced staff to meet people's needs. We saw people's complaints were fully investigated and resolved, where possible to their satisfaction. People's records were fit for purpose, kept securely and could be located promptly when needed.

People told us that staff looked after them well and supported them as and when needed in their personal care needs. One person said 'I get support from staff when I want' another person said that 'the nurses are wonderful; they can only do so much'.

People told us that they felt safe and were able to express their views and concerns to staff and the manager. Relatives of the people who used the service said they had no concerns to raise about the safety and welfare of their relative.