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Inspection carried out on 28 October 2019

During a routine inspection

About the service:

Kimbolton Lodge is a residential care home providing personal and nursing care to 36 younger and older adults at the time of the inspection. The service can support up to 36 people. The service consists of two floors which had been adapted to support people’s needs. People had their own bedrooms and shared facilities such as dining rooms, lounges, bathrooms and a garden. Some people used the service for rehabilitation following a stay in hospital.

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

People were happy with the care they received from staff at the service. One person said, ‘‘Everyone is very kind here. If you need help you get it and [staff] get to know how you like to be supported. We all help each other like one big family and I am very happy here.’’

Staff were kind and compassionate and treated people as individuals, involving them in all aspects of their care. People’s privacy and dignity was respected, and people were encouraged to maintain their independence. Staff knew people’s likes, dislikes, communication methods and preferences and supported them according to these. A wide variety of activities both at the service and in the community were available for people to take part in. The service was designed to meet the needs of people using the service.

People felt safe and were protected from harm and abuse by systems in place at the service. Risk assessments were in place to keep people safe whilst allowing them to take positive risks. People were supported safely with their medicines and good infection control measures were in place at the service.

Staff members were trained and competent in their job roles and there were enough staff to meet people’s needs safely. People were also able to spend meaningful time with staff to help staff get to know them well. A complaints procedure was in place if people wanted to make a complaint about the service. People had plans in place for the end of their life and staff members had a good understanding of how to support people at this time.

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. People were supported to eat a healthy diet and were supported to see health professionals if this support was needed.

There was a positive culture at the service and the registered manager and staff team were passionate about achieving good outcomes for people. The registered manager and senior staff completed audits and put actions in place to monitor and improve the quality of the service. People, relatives and staff were able to feedback, and this was used to improve the service. The registered manager and staff team linked with other organisations to support people with their well-being.

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 good (report published 4 May 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 13 April 2017

During a routine inspection

This inspection took place on 13 April 2017 and was unannounced.

Kimbolton Lodge is a care home registered to provide nursing or residential care for up to 36 people. At the time of our inspection there were 33 people using the service.

The service has a registered manager. 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 and associated Regulations about how the service is run.

People felt safe. Staff had been provided with training to enable them to recognise signs and symptoms of abuse and they knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and keep them safe. . Adequate staff with the appropriate skill mix were available to support people with their needs. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service.

Systems were in place to ensure that medicines were managed safely. This ensured that people received their medicines at the prescribed times.

Staff received appropriate training, supervision and support to enable them to carry out their roles and responsibilities effectively. People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation.

People were able to make choices about the food and drink they had and to maintain a healthy and balanced diet. If required, staff supported people to access a variety of health professionals including the dentist, optician, chiropodist, dietician and the speech and language therapist.

People and their relatives commented positively about the standard of the care provided. Staff provided care and support in a meaningful manner; and knew about people’s preferences and personal histories. People’s views were listened to and they were actively encouraged to be involved in their care and support. Staff ensured that people’s privacy and dignity was upheld. Any information about people was respected and treated confidentially.

People’s needs were assessed before coming to live at the service and the care plans reflected how their needs were to be met. People were supported to take part in meaningful activities and pursue hobbies and interests. There was a complaints procedure in place to enable people to raise complaints.

There was a culture of openness, transparency and inclusion at the service amongst staff and people using the service. A variety of quality audits were carried out, which were used to drive continuous improvement.

Inspection carried out on 27 October 2016

During an inspection to make sure that the improvements required had been made

This inspection took place on 27 October 2016 was unannounced.

We carried out an unannounced comprehensive inspection of this service on 04 August 2016. Breaches of legal requirements were found. As a result we undertook a focused inspection on 27 October 2016 to follow up on whether action had been taken to deal with the breach.

You can read a summary of our findings from both inspections below.

Following our previous comprehensive inspection, on 04 August 2016 we found that people were not always protected against the risks associated with unsafe or unsuitable premises. Some areas of the service had not been maintained to a safe standard and repairs had not been carried out in a timely manner. This meant that areas of risk that may be hazardous to people's safety and health had not always been identified and rectified as soon as possible.

This was in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also saw that recruitment procedures needed to be strengthened to ensure only suitable staff were employed by the service. We observed that some employment checks for a small number of staff had not been obtained.

This was in breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition there were insufficient numbers of suitably qualified, competent, skilled and experienced staff providing care or treatment to people. People’s needs were therefore not met in a timely manner because of the impact that this had.

This was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found there were inconsistencies with the recording and administration of medicines. Records were not always fully completed and we found that people did not always receive their medicines as prescribed.

This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Quality assurance and health and safety checks had not been undertaken consistently and had not therefore effectively checked the care and welfare of people using the service.

This was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations2014.

The provider submitted an action plan to tell us how they would meet these regulations and the timescale they intended to have met them by. We carried out this inspection on 27 October 2016 to see if the provider had made the necessary improvements to meet the breaches of regulation. During this inspection we found that the provider had implemented systems that had improved the provision of service.

Kimbolton Lodge is registered to provide nursing or residential care for up to 36 people. On the day of our visit, there were 33 people using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

Significant improvements had been made to the premises to ensure the service was complaint with fire safety and health and safety requirements. In addition we saw that risk assessments in relation to the premises had been reviewed and updated and environmental audits and checks were being undertaken of the service on a monthly basis.

Improvements had been made to the recruitment process to ensure only staff who were suitable to work at the service were employed. All staff files examined contained all the necessary employment checks required.

Staffing levels and the deployment of staff had been improved and there were sufficient numbers of staff to meet people’s needs in a timely manner.

Systems for the safe administration of medication had been improve

Inspection carried out on 4 August 2016

During a routine inspection

This inspection took place on 04 August 2016 and was unannounced.

We carried out a first inspection on 24 November 2014. This was the second comprehensive inspection carried out at Kimbolton Lodge.

Kimbolton Lodge is registered to provide nursing or residential care for up to 36 people. On the day of our visit, there were 34 people using the service.

The service had a registered manager but she was not available during this 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 and associated Regulations about how the service is run.

People had not been protected against the risks associated with unsafe or unsuitable premises. Some areas of the service had not been maintained to a safe standard and repairs had not been carried out in a timely manner. Actions identified as needing improvement from the most recent fire authority inspection and a health and safety check had not been addressed. This meant that areas of risk that may be hazardous to people’s safety and health had not always been identified and rectified as soon as possible.

Recruitment procedures needed to be strengthened to ensure only suitable staff were employed by the service. We observed that some employment checks for a small number of staff had not been obtained. There were insufficient numbers of suitably qualified, competent, skilled and experienced staff providing care or treatment to people. People’s needs were therefore not met in a timely manner because of the impact that this had.

Systems and processes in place for the administration, storage and recording of medicines were not always safe. This meant that people’s care and treatment was not provided in a safe way. The registered provider had failed to deliver the safe and proper management of medicines which had subsequently placed people’s health and wellbeing at immediate risk.

Although we found staff to be kind and caring we observed them to be largely task focused due to insufficient staffing numbers. The privacy and dignity of people was not always promoted by staff because their personal care needs were not always responded to in a timely manner. .

Quality assurance, health and safety checks and feedback from people had not been undertaken consistently and did not therefore effectively check the care and welfare of people using the service. This meant that systems in place were not effective or robust enough to ensure that risks relating to the health, safety and welfare of people using the service were responded to.

People told us they felt safe at the service. Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to use the whistleblowing procedure. Risk assessments were centred on the needs of the individual and any potential risks to people had been identified. We saw that risk management plans had been completed to enable them to live as safely as possible.

Staff were well trained and aspects of training were used regularly when planning care and supporting people with their care and support needs. People told us and records confirmed that all of the staff received regular training in mandatory subjects. In addition, we saw that specialist training specific to the needs of people using the service had been completed. This had provided staff with the knowledge and skills to meet people’s needs in an effective and individualised way.

Staff sought people's consent to care and treatment which was in line with current legislation. People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required.

People told us they were treat

Inspection carried out on 24 November 2014

During a routine inspection

Kimbolton Lodge is registered to provide accommodation and support for up to 35 older people who may require nursing or residential care. On the day of our visit, there were 30 people living in the home.

The service had a registered manager. 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 and associated Regulations about how the service is run.

At our last inspection on 27 August 2014, we found that the service had breached regulations in respect of suitability of staff. We found that some people were cared for by staff that could not demonstrate they had received the necessary training to deliver care and treatment safely to an appropriate standard. Following this inspection, the provider sent us an action plan in September 2014 to tell us the improvements they were going to make.

During our inspection on 24 November 2014, which was unannounced, we reviewed whether these actions had been completed. We looked at the previous non-compliance and found that suitable action had been taken to ensure compliance had been achieved.

People told us they felt safe and we found that the systems in place to protect people from the risk of harm were suitable. Staff knew how to recognise and respond to abuse correctly.

We found the staff knew what to do if they had any concerns about people’s welfare. Staff had received training on safeguarding adults, the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). They also knew how to manage risks to promote people’s safety, balanced with their right to take risks

Staff working in the home understood the needs of the people who lived in the home and we saw that care was provided with kindness and compassion. People and their families told us they were happy with their care.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

The provider had a robust recruitment process in place. Records we looked at confirmed that staff started work in the home after all recruitment checks had been satisfactorily completed. Staff we spoke with told us that they had not been offered employment until these checks had been confirmed.

The registered manager was accessible and approachable and led the service in a positive and constructive manner.

Staff, people who used the service and relatives told us that they felt able to speak with the manager and provided positive feedback on the service which the registered manager told us would be used to drive future improvements.

Inspection carried out on 27 August 2014

During an inspection in response to concerns

We considered all the evidence we had gathered under the outcome we inspected during our inspection at Kimbolton Lodge. We used the information to answer the five questions we always ask relevant to this outcome.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive to people's needs?

• Is the service well led?

This is a summary of what we found:

At the time of our inspection there was no registered manager in post. The person who had been managing the service, but had not registered with us, had recently resigned. The position had been filled by an acting manager. In this report the names of two registered managers appear who were 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. This was because they had failed to inform us they were no longer managing the service.

Is the service effective?

Staff we spoke with had a good understanding of people’s needs and knew how they preferred to be looked after and treated. This meant people were supported appropriately in relation to their needs. However the records we looked at demonstrated that the range of needs the staff team could care for was not extensive and a result some people who wanted to be cared for at Kimbolton Lodge had to be refused admission.

Is the service caring?

Records showed that the staff would request advice and support from other health professionals if they were in any doubt about how effective care should be provided. This would ensure people received the care they needed but relied on the availability of other professionals to provide this support.

Is the service well- led?

Robust systems were not in place to ensure that staff had the right skills to care for people safely. This meant it was not clear exactly which conditions staff could provide safe care and support for.

Inspection carried out on 9 July 2013

During a routine inspection

During our inspection of Kimbolton Lodge on 9 July 2013, we spoke with nine of the 29 people using the service and with two relatives visiting the home. We also observed the care provided to the majority of those we did not speak with. People told us they were happy living at Kimbolton Lodge. One person said, “There is nothing bad about this place, everything is wonderful.” Another person, who had regular respite at the home, told us she looked forward to her stays and treated it as a holiday.

Throughout we observed a friendly, inclusive and homely environment. Staff interacted well with the people using the service. One person said, “The staff are all good and the manager is a marvel.” People were encouraged to socialise and join in planned events. We visited on a very warm day and observed that no one was restricted from accessing the gardens, through the open ground floor doors. One lady sitting in the garden said, “It is lovely out here, it is like being on holiday.”

We observed that care was delivered in line with the care plans and that people were asked to consent to any care before it was delivered. One person said, "I am being taken into town tomorrow ( and referred to a care worker) for new shoes." There were sufficient staff on duty at all times and staff told us they had good learning and training opportunities.

The home had systems in place to effectively manage complaints.

Inspection carried out on 16 April 2012

During a routine inspection

When we visited Kimbolton Lodge during the afternoon and early evening of 16 April 2012 we spoke with ten of the people living at the home and three visitors. People told us that the staff were always polite when they spoke with them. A person who had not lived at the home very long told us that the staff had asked her a lot of questions about her preferences, including the name she preferred to be addressed by, when she liked to get up and go to bed, and what foods she particularly enjoyed as part of her admission. We were told that people had the opportunity to visit Kimbolton Lodge in advance of their admission and given information about the home.

People also told us that they were happy living at Kimbolton Lodge and believed that the care they received met their needs. One person said, “I am really happy here, they look after me so well”. We were told that the food was good and choices were offered at mealtimes.

People told us that they felt safe and well cared for and were looked after appropriately. We also observed that people looked comfortable and at ease in the company of the staff.

Four people that talked to us about staffing levels told us that there was always staff to call upon. A fifth person said that they sometimes had to wait for staff when they called. They were unable to tell us how this impacted on them, other than causing them frustration if they wait for their care. A visitor told us that the staff were always friendly and available to talk to them. We were also told that the manager made herself available to speak with relatives at any time and had held formal meetings with them.

Inspection carried out on 19, 20 April 2011

During a routine inspection

We made a visit to the service on 20 April 2011, during which we spoke with eight people living at Kimbolton Lodge and observed the care provided to most.

People told us that the staff treated them with respect and asked them about how they wanted their care to be provided. They also confirmed that they were able to make decisions about their care and how they spend their time.

The people that we spoke with during our visit were positive about the support they received from the staff team and confirmed that the staff providing care did so in a caring way. For example, we were told that the staff looked after resident’s medication and made it available as and when they wanted it. One person told us how grateful they were for this, as in the past they had often forgotten to take their medication. No one suggested that they had to wait for medication when they needed it.

People told us that the food provided was good and plentiful and, although some people made comments about preferring stronger flavours or different ways of preparing a certain dish, all were confident that if they had any real requests these would be granted. One person said, “I am sure if I asked for spicy food I would get it but you have to consider the other people living here.” People told us that the cook regularly asked them about the meal they wanted or if they had enjoyed the meal that had been served. In addition, people told us how they were able to influence changes in the home by either voicing concerns at residents’ meeting or completing the satisfaction surveys they were given.

Although the bedrooms were all very different, everyone we spoke with was happy with the room they had. We saw that they had been able to personalise their bedrooms with belongings, and even small items of furniture, from home.

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