Archived: Kingswood Court Care Home

Kingswood Court Care Home 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. At the time of our inspection there were 40 people at the home.

At our last inspection we found two breaches that related to medicines and consent. At this inspection we found actions had been taken to ensure the regulations had been met and the service had improved.

There was not a registered manager in post. The provider had recruited a manager who was in the process of registering with the Care Quality Commission to carry on regulated activities at the home. 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.

People and their relatives told us they felt the service was safe and they were complimentary about the staff and how caring they were. They stated that staff were very kind and they had no concerns about their safety. Staff had received training in relation to safeguarding and they were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse.

Staff had received training, regular supervisions and annual appraisals that helped them to perform their duties. New staff commencing their duties received induction training to help prepare them for their role. Staff told us that they worked with another member of staff until they and their registered manager felt they were competent to work on their own.

There were enough staff to ensure that people’s assessed needs could be met. It was clear that staff had a good understanding of how to attend to people’s needs. The provider had carried out full recruitment checks to ensure staff were safe to work at the home. Risks to individual people had been identified and written guidance for staff about how to manage risks was being followed.

Accidents and incidents were recorded and monitored by staff at the home to help minimise the risk of repeated events.

Medicines were managed in a safe way and the recording of medicines was completed to show people had received the medicines they required. Staff were knowledgeable about people’s medicines and explained to people what their medicines were for.

The environment was very clean and tidy there were no malodours at the home. Staff followed good practice guidance in relation to infection control to minimise the risk of cross infections.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.

Staff supported people to eat a good range of foods. Those with a specific dietary requirement were provided with appropriate food. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private. People took part in a variety of activities that interested them. People’s relatives and visitors were welcomed and there were no restrictions of times of visits.

Documentation that enabled staff to support people and to record the care they had received was up to date and regularly reviewed. People’s preferences, likes and dislikes were recorded.

A complaints procedure was available for any concerns. This was displayed at the service. No complaints had been received, but the registered manager and staff had received many letters complimenting them on the care they provide to people.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were attended to by staff. People, relatives and associated professionals had been asked for their views about the care provided and how the home was run. Regular resident and relatives and staff meetings took place.

Interruption to people’s care would be minimised in the event of an emergency. The provider had Business Continuity Plan that detailed how staff would manage the service in the event of adverse incidents.

At the time of our visit there was a registered manager 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.

People were at risk of harm as safe medicines practices were not always followed. Catering staff were not made aware of people’s needs where their diet may affect the efficiency of their prescribed medicines. People told us that they were happy with the support they received to manage their medicines. Any changes to people’s medicines were verified and prescribed by the person’s GP.

Staff did not have a clear understanding of their responsibilities regarding the Mental Capacity Act or Deprivation of Liberty Safeguards. Where people lacked capacity they were not fully protected and best practices were not being followed.

There were systems and arrangements to monitor and improve the quality of the service. We have recommended that further improvements are made.

People had mixed comments about whether there were enough staff on duty, people told us that on occasions they had to wait before staff attended to them. We identified that staffing levels had an impact on the care and range of activities provided. We recommend that the registered provider reviews the layout of the home when determining the deployment of staff.

People told us they felt safe at Kingswood. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. A relative told us, “I feel that mum is very safe here, staff are very caring.” There were systems and processes in place to protect people from abuse and staff had received safeguarding training. Recruitment practices were safe, were followed and relevant checks had been completed before staff commenced work.

Staff were knowledgeable about people’s needs, and how to care for people who were distressed or at risk of harm. Information recorded about how to provide support to people who were prone to falls, people being feed through tubes and people using bed rails. Where people were at risk of developing pressure sores there was a plan in place to reduce this risk which were followed by staff. People were supported to take risks safely. People with limited mobility, were not prevented from moving around and were actively supported by staff who looked after them safely.

Fire safety arrangements and risk assessments for the environment were in place to keep people safe. Each person had a personalised emergency evacuation plan and staff carried out regular fire drills and evacuations so they knew what to do in the event of a fire. There was a contingency plan in place should an emergency have an impact on the delivery of care.

Equipment was checked and serviced regularly to ensure it was in safe working order.

Staff had the appropriate guidance in relation to their role. The registered manager ensured staff had the skills and experience which were necessary to carry out their responsibilities.

People had mixed feelings about the food at the home. People were supported to have their nutrition and hydration needs met. People who were able to eat independently were prompted and encouraged to do so. Where people needed support, they were supported by a member of staff. Throughout the meal we observed staff interacting with people and asking them about the food.

People had access to healthcare professionals such as the GP, district nurse, optician, dentist, physiotherapist, speech and language therapist to support their well-being. The service worked effectively with health care professionals and referred people for treatment when necessary.

We have recommended that the provider continues to plan and take action to provide a suitable environment for people living with dementia to aid their wellbeing and independence.

Staff knew about the people they supported. We saw information in care records that highlighted people’s personal preferences, so that staff would know what people needed from them. We observed where a person was distressed the staff member reassured them.

Staff showed kindness to people and interacted with them in a positive way. Staff were caring. Staff were observed knocking on people’s bedrooms doors before entering. People’s privacy was respected by staff. Relatives and friends were encouraged to visit and maintain relationships with people.

People and their relatives were given support when making decisions about their preferences for end of life care. Where necessary, people and staff were supported by palliative care specialists. Services and equipment were provided as and when needed.

People had access to activities, however there were mixed feelings about the activities provided. The range of activities available was not always appropriate or stimulating for people. We have recommended that the provider reviews individual hobbies and interests and looks for ways of increasing group and individual participation.

Care records did not reflect up to date information regarding people's care or support needs which meant new or agency staff who did not know people might not be working to the most up to date information.

Staff were quick to respond to people’s needs. The registered manager told us by having a consistent staff team they were able to build up a rapport with people and that people were cared for by staff they knew and who understood their needs

People and relatives confirmed that they were aware of the complaints system. There was mixed feelings about the way complaints were handled. However the provider had been following their complaints procedures and taking action to resolve complaints wherever possible.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made two recommendations to the provider. You can see what action we told the provider to take at the back of the full version of this report.

All of the people we spoke with were happy living in Kingswood Court. One person said 'It's extremely well run' and another told us 'Can't speak highly enough of it.'

We heard from everyone we spoke with that there was a good range of activities on offer each day. People could choose whether or not they wished to participate. We saw that there were different areas in the home that provided peace and quiet should people want it.

When we asked people's opinions on the quality of the food we were told 'The food is good ' we can have something different if we want it.'

We saw that the provider had good recruitment processes in place and that they ensured that only suitable and qualified staff were employed.

There were systems in place that monitored the quality of the service. People were positive about the service. One relative who spoke with us about the staff told us that 'Couldn't have a higher regard for them.'

The feedback we received from residents about the care they received was universally positive. Residents told us that staff were available when they needed them and that they were always polite and treated them with respect. One person said, 'They look after me very well. They're very helpful; always keen to please.' and another told us, 'The staff are excellent. They're very cheerful. They keep us going.'

Relatives confirmed that their family members received good care and support. One relative said, 'I have a very high regard for this home. The care is top class.' Another relative said, 'They treat people with respect and tender, loving care.'

Residents told us they were encouraged to contribute their views about the care they received and that their ideas and suggestions were acted upon. We found that any complaints received were appropriately investigated and that complaints were monitored regularly to identity areas for improvement.

Staff were positive about their roles. They told us that they enjoyed working at the home and that the manager was approachable and supportive. They confirmed that they had a comprehensive induction when they started work and access to the training and support they needed to do their jobs.