This comprehensive inspection took place on 13 August 2017 and 7 September 2017 and was unannounced. At the last comprehensive inspection on 27 September 2016, the service was rated as ‘Good’ overall. This comprehensive inspection was undertaken in response to information of concern we received, which included allegations that people were not always provided with safe care and treatment.Kingsland House is registered to provide nursing and residential care for up to 71 people with a range of healthcare needs, including people living with dementia and chronic conditions. On the first day of our inspection, there were 66 people living at the service. On the second day of our inspection, there were 62 people living at the service, as some people were in hospital, or had sadly passed away. Kingsland House is a purpose-built care home which is divided into two units: Memory Lane, which accommodates people living with dementia and Bluebell, which accommodates people with a range of health and nursing needs.
A registered manager was in post. 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 were told that staffing levels had been assessed based on people’s care and support needs. However, people, relatives and staff felt that there were insufficient numbers of staff on duty at certain times of the day and night to ensure people’s safety. Our own observations supported this.
Certain aspects of the management of medicines required improvement and we saw that safe procedures for the giving people their medicines were not routinely being followed.
Several people commented they were well looked after by care staff. However, care was not always personalised to the individual. For example, people did not always get up or spend their day how they wished. It was recognised that staff had a good understanding of person centred care and knew people’s routines well. However, staffing levels at the service did not allow staff to routinely meet people’s preferences in relation to how their care was delivered.
There was a range of quality assurance systems to help ensure a good level of quality of care was maintained. However, these systems had not fully ensured that people received a consistent and good quality service that met individual need, specifically in relation to the assessment of staffing levels.
Unpleasant odours and the smell of urine were evident in Memory Lane at the time of our inspection and cleanliness was not of a high standard.
People were complimentary about the food and drink on offer. There was a varied daily choice of meals, special dietary requirements were met, and people’s weight was monitored. However, improvements were needed to the mealtime experience, and people’s food preferences being met in some parts of the service.
Care plans were accurate, however three out of the 10 we looked at lacked information to guide staff when people’s needs had changed.
Although some staff spoke positively of the culture and how they all worked together as a team, feedback from other staff was mixed and indicated that there was a lack of cohesion, support and a negative culture in the service. We received mixed feedback from people, relatives and staff in relation to the service being well led.
Staff had received essential training and there were opportunities for additional training specific to the needs of the service. Staff had received both one-to-one and group supervision meetings, and formal personal development plans, such as annual appraisals were in place. However, some improvement was required in relation to the induction provided for agency staff.
When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.
People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).
Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.
People took part in activities in the service and outside the service. They told us they enjoyed the activities, which included singing, films, arts and crafts and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.
People told us that friendly and genuine relationships had developed between them and staff. They also said they felt listened to and confident that they could raise any concerns or issues. Health care was accessible for people and appointments were made for regular check-ups as needed.
We found several 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 this report.
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.