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Kingsmead Care Centre Requires improvement

We are carrying out a review of quality at Kingsmead Care Centre. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 3 September 2019

During a routine inspection

About the service:

Kingsmead Care Centre is a care home providing personal and nursing care to people with a range of needs in two units, both of which are located in one building. Kingsmead Haven provides nursing care and accommodation for people with a learning disability, physical disability and/or acquired brain injury and other complex needs. The nursing unit provides nursing care and accommodation for older people with a variety of healthcare needs and physical frailties including some people living with dementia. At the time of the inspection, nine people were receiving care in Kingsmead Haven and 11 people were receiving care in the nursing unit. The support can support up to 34 people.

Kingsmead Care Centre is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation. This does not include Kingsmead Care Centre, but the investigation is on-going, and no conclusions have yet been reached.

Kingsmead Care Centre had been built and registered before the CQC policy for providers of learning disability or autism services 'Registering the Right Support' (RRS) had been published. The guidance and values included in the RRS policy advocate choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen.

Kingsmead Care Centre requires further development to be able to deliver support for people that is consistent with the values that underpin RRS. For example, the care planning process did not always consider people’s goals, aspirations or promotion of independence.

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

Risks to people were not always assessed and mitigated. For example, risks associated with behaviours which challenge and moving and handling. People were not always supported to have maximum choice and control of their lives. The application of the Mental Capacity 2005 was inconsistent and capacity assessments were not always completed in line with legislation or in a person-centred way.

The provision of activities required further development. Activities were not consistently meaningful or tailored to people’s needs. The care planning process required further development to ensure people’s social and emotional needs were understood and met. Further work was required to ensure information about people’s care and treatment was always made available in the most accessible way. Staff were responsive to people’s needs, however, we observed an interaction whereby staff failed to recognise that a person was in distress.

Quality assurance frameworks were in place; however, these were not consistently effective in driving improvement or identifying shortfalls. Accurate documentation was not consistently maintained.

People told us that they felt safe living at Kingsmead Care Centre. Staff had received training on safeguarding adults and understood their roles and responsibilities to safeguard people from harm or abuse. The manager worked in partnership with healthcare professionals and learning was derived from incident, accidents and safeguarding concerns.

Staff felt supported and had access to a range of training. People’s nutritional needs were met and people spoke highly of the food provided. Risks associated with catheter care, constipation and diabetes were managed well. People had ongoing access to healthcare professionals and staff recognised and responded well to signs that a person’s health might be deteriorating.

Staff knew people well and demonstrated warmth towards the people they supported. People were involved in day to day decisions about their care and relatives could visit at any time.

A complaints policy was available in an accessible format and peop

Inspection carried out on 18 September 2018

During a routine inspection

This inspection took place on 18 September 2018 and was unannounced.

Kingsmead Care Centre 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.

Kingsmead Care Centre provides accommodation and nursing care to people with a range of needs in two units, both of which are located in one building. Haven provides nursing care and accommodation for people with a learning disability, physical disability and/or acquired brain injury and other complex needs. The nursing home provides nursing care and accommodation for older people with a variety of healthcare needs and physical frailties including some people living with dementia. Kingsmead Care Centre is registered to provide nursing care and accommodation for up to nine people in Haven and up to 25 people in the nursing home. There were nine people living in Haven and ten people living in the nursing home.

There was a well-established registered manager in post. A registered manager is a person who has registered with the CQC 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.

Kingsmead Care Centre has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. Kingsmead Care Centre was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Kingsmead Care Centre in response to changes in best practice guidance. Had the provider applied to register Kingsmead Care Centre today, the application would be unlikely to be granted. The model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a

learning disability and/or Autism should be operated to meet their needs. People with learning disabilities using the service should be able to live as ordinary a life as any citizen.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going and no conclusions have been made. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and July 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

At our last inspection in June 2017 we rated the service Requires Improvement overall and the service was found to be in breach of legal requirements. At that inspection we found systems to assess and monitor the service were in place but these had not been sufficiently robust as they had not identified a lack of consistency and gaps within agency nurse training on specific subjects such as PEG management and learning disability training. Whilst people's risks had been assessed, identified and mostly managed appropriately, there had been a lack of guidance available for staff regarding people’s specific health needs such as asthma. We had also found that there was a lack of personalised activities provided.

This inspection found that improvements had been made and the breaches of Regulation 18 and 17 met, but there were still improvements to be made to fully meet Regulation 9. The overall rating has remained as Requires Improvement.

We found the activities and stimulation opportunities provided to people were still inconsistent across the home. People had activity plans in

Inspection carried out on 21 September 2017

During a routine inspection

The inspection of Kingsmead Care Centre took place on 21 September 2017 and was unannounced.

Since the previous inspection of Kingsmead Care Centre in October 2016, services operated by the provider had been subject to a period of increased monitoring and support by commissioners. Kingsmead Care Centre had been the subject of one safeguarding concern about person-centred care delivery. As a result of concerns raised across the provider’s 19 locations, the provider is currently subject to a police investigation. Our inspection did not examine specific incidents and safeguarding allegations which have formed part of these investigations. However, we used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May and September 2017, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Kingsmead Care Centre provides accommodation and nursing care to people with a range of needs in two units, both of which are located in one building. Haven provides nursing care and accommodation for people with a learning disability, physical disability and/or acquired brain injury and other complex needs. The nursing home provides nursing care and accommodation for older people with a variety of healthcare needs and physical frailties including some people living with dementia. Kingsmead Care Centre is registered to provide nursing care and accommodation for up to nine people in Haven and up to 25 people in the nursing home. At the time of our inspection the home had no vacancies. All rooms are of single occupancy, including two double rooms in the nursing home. In Haven, there is a large community room which is utilised for activities and as a sitting and dining area. In the nursing home, there is a large sitting room with activities area and a separate dining room.

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.

At the last inspection on 18 and 19 October 2016 the service was found to be complying with legal requirements and was given a rating of ‘Good’. However, at this inspection we found the quality of care and safety had deteriorated and we identified breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found systems to assess and monitor the service were in place but these were not sufficiently robust as they had not identified what we highlighted at this inspection such as a lack of consistency and gaps within agency nurse training on specific subjects such as PEG management and learning disability training.

At the last inspection we spoke with the provider about the need to ensure all staff received training on specific subjects relating to the needs of the people living at the home. Training opportunities had been provided since the last inspection however a significant amount of staff still needed to attend. At the last inspection in we found improvements were needed to ensure all staff received consistent supervision from their line manager. At this inspection we found improvements had been made and all staff were happy with the support they received and records confirmed this.

People's risks were assessed, identified and mostly managed appropriately. However, we found a lack of guidance available for staff regarding the support one person needed with their asthma. Other risk assessments were contained within people's care plans and were reviewed monthly or, as needed, following an incident or

Inspection carried out on 18 October 2016

During a routine inspection

The inspection took place on 18 and 19 October 2016 and was unannounced.

The last inspection took place in August 2015. As a result of this inspection, we found the provider in breach of a regulation relating to safe care and treatment and asked them to submit an action plan on how they would address this breach. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found that the provider and registered manager had taken appropriate action and the regulation had been met.

Kingsmead Care Centre provides accommodation and nursing care to people with a range of needs in two units, both of which are located in one building. Haven provides nursing care and accommodation for people with a learning disability, physical disability and/or acquired brain injury and other complex needs. The nursing home provides nursing care and accommodation for older people with a variety of healthcare needs and physical frailties; some people have associated dementia needs. Kingsmead Care Centre is a modern, purpose-built nursing home, situated in its own grounds, with gardens and dedicated parking. It is registered to provide nursing care and accommodation for up to nine people in Haven and up to 25 people in the nursing home. At the time of our inspection, nine people were living in Haven and 23 in the nursing home. Two of the beds in the nursing home are reserved for people who require short breaks or care and support that enables them to move back to their own home or into other care settings. All rooms are of single occupancy, including two double rooms in the nursing home. In Haven, there is a large community room which is utilised for activities and as a sitting and dining area. In the nursing home, there is a large sitting room with activities area and a separate dining room.

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.

People’s risks were assessed, identified and managed appropriately. A range of risk assessments were contained within people’s care plans and were reviewed monthly or, as needed, following an incident or accident. Staff had been trained to recognise the signs of potential abuse and people told us they felt safe living at the home. Staffing levels were assessed based on people’s needs using a dependency tool. In the nursing home, some staff felt rushed in delivering personalised care to people and that some people might have to wait for staff to attend to them, especially at busy times of the day. New staff were recruited following appropriate checks on their suitability. Medicines were managed safely.

Staff completed training in a range of areas and new staff followed the Care Certificate, a universally recognised qualification. Staff were required to attend supervision meetings three times a year and to have an annual appraisal. However, not all staff had received supervisions with this regularity and the provider had identified this as an area for improvement. Team meetings were organised. Staff understood how to gain people’s consent to their care and treatment, but some staff did not have a thorough understanding of the Mental Capacity Act 2005. People felt there was a good choice of food on offer and they were involved in menu planning at residents’ meetings. People were supported to maintain good health and had access to a range of healthcare professionals and services. Individual rooms were personalised in line with people’s tastes and preferences.

People were looked after by kind and caring staff who knew them well and how to meet their needs. People’s personal histories, preferences, likes and dislikes w

Inspection carried out on 18 and 19 August 2015

During a routine inspection

The inspection took place on 18 and 19 August 2015 and was an unannounced inspection.

Kingsmead Care Centre provides accommodation and nursing care for up to 34 people. The service consists of two parts. The main part of the service caters for 25 older people whilst Haven supports nine people with physical and/or learning disabilities. The service is managed as one but staff tended to focus in one or other part of the service. Activities were mostly organised separately to cater for people’s different interests and abilities. At the time of our visit, there were 29 people in residence.

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 2008 and associated Regulations about how the service is run.

We identified issues in how risks to people’s safety were assessed and mitigated. Information for staff on how to mitigate risks was not always available or consistent. Furthermore, when additional steps to keep people safe were identified, these were not promptly updated in people’s records. This lack of clear guidance for staff could lead to people receiving inconsistent or unsafe care.

There was a system in place to assess and monitor the quality of the services provided. This included audits and checks at both service and provider level. The provider also commissioned external audits of the service. The registered manager had taken action in response to audits and there was clear evidence of improvement in the service. We noted, however, that some actions had not been marked as completed and were not carried forward. We discussed this with the registered manager with a view to ensuring that the systems in place were used effectively.

People, relatives and staff spoke highly of the service and staff. In relatives’ comments to a survey conducted by the provider we read, ‘I cannot fault the care my Mum is receiving at Kingsmead. All the staff are very caring and try very hard to keep the residents happy’. A card of thanks read,

‘We will always remember your dedication, your wisdom and your compassion’. The home was staffed by a regular staff team who knew people well and understood how they liked to be supported. Staff were able to communicate effectively with people, including those who had limited verbal communication.

Staff understood how people’s capacity should be considered and had taken steps to ensure that their rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to be as independent as they were able and to make decisions relating to their care and treatment. People received their medicines safely.

People were happy with the choice of food on offer at the service. Staff offered alternatives and made sure that people were eating and drinking enough to meet their needs. If concerns, such as weight loss, were identified, referrals were made to the GP or other healthcare professionals. Professionals involved with the service told us that they followed their advice and worked effectively to meet people’s needs.

Staff had received recent training in line with their responsibilities and had attended supervision meetings with their managers to discuss their work and professional development. New staff received support and training which included shadowing experienced staff as they got to know people.

There was a relaxed and happy atmosphere at the home. People felt safe and were able to speak up if they had concerns. People, staff and relatives told us that they were able to approach the registered manager or provider if they had suggestions to make. They felt confident that they would be listened to. There were regular meetings for residents and surveys were used to gather feedback, including from relatives.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.