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Inspection carried out on 16 December 2020

During an inspection looking at part of the service

About the service

Kingsbury Court is a care home which provides accommodation and personal care for up to 60 people, many of whom are living with dementia or have a nursing need. The service is divided into three separate living quarters, each with their own dining and communal areas. At the time of our inspection 57 people were living at the service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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

People told us they felt safe at the service and were treated well by staff. Risks to people were managed well and appropriate assessments and care planning was in place to keep people safe. We did however find some shortfalls in documentation about people’s medical conditions which we raised with the manager.

The provider had made efforts to recruit more staff since our last inspection although we still received a mixed response about how quickly staff attended to people. In turn, staff felt there had been an improvement in staffing levels though at times they still felt under pressure. The manager told us they would start call bell response monitoring to assess staffing levels.

We were assured by the provider’s infection control processes. Staff were adhering to Government guidance and helping to ensure people were kept free from risk of catching COVID-19. People’s medicines were managed well and in the event people had an accident or incident, action was taken and lessons were learnt.

The service was without a registered manager. Although there was a manager present within the service, they had not completed their registration with CQC. We found the manager was making positive changes and had a clear vision for the future. Staff told us they felt supported and had already seen improvements and people were positive about the new manager.

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 18 December 2019).

Why we inspected

This focused inspection was prompted due to the information we held about the service indicating that people may not be receiving safe care.

At this inspection we reviewed the Key Lines of Enquiry in the key questions of Safe and Well-Led only and this report covers our findings in relation to those.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsbury Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme when we will carry out a fully comprehensive inspection looking at all key questions. If we receive any concerning information we may inspect sooner.

Inspection carried out on 18 November 2019

During a routine inspection

About the service

Kingsbury Court is a care home providing personal and nursing care to 46 people aged 65 and over at the time of the inspection. The service can support up to 60 people. The service is a large purpose-built building, over three floors based in Woking Surrey.

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

People did not always receive support from adequate numbers of staff deployed to keep them safe. However, there had recently been a successful recruitment drive. People continued to be protected against abuse, as staff received safeguarding training and knew how to respond to, escalate and report suspected abuse. Risk management plans gave staff guidance to mitigate identified risks. People were supported to receive their medicines in line with good practice. Infection control practices ensured people were protected against cross contamination.

Staff received on-going training to enhance their skills. Staff reflected on their working practices through supervisions. People were supported to access food and drink that met their dietary needs and preferences. People continued to be encouraged to live healthier lives and had access to healthcare services to monitor and maintain their health.

People continued to be treated with kindness and compassion. People’s dependency levels were recorded, and support provided adjusted to their changing needs. People were supported and encouraged to make decisions about their care and had their dignity respected.

Personalised care plans enabled staff to deliver care in line with people’s needs and wishes. There were a wide range of activities for people to participate in. People received information in accessible formats. Complaints were managed quickly to seek a positive outcome and minimise the risk of repeat incidents. People’s end of life care preferences were documented.

We received mixed comments about the management of the service. The registered manager carried out audits to drive improvements. The registered manager worked in partnership with other stakeholders to enhance people’s lives. People continued to be encouraged to share their views of the service.

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.

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 (published 12 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsbury Court on our website at www.cqc.org.uk.

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 28 March 2017

During a routine inspection

The inspection took place on 28 March 2017 and was unannounced.

Kingsbury Court opened in April 2015 and provides accommodation, care and support for up to 60 people, some of whom may be living with dementia. The service is registered to provide nursing care although this area of the service had not commenced at the time of our inspection. The registered manager told us that nursing staff had been recruited and they anticipated that nursing care would be provided within the next two months. There were 34 people living at Kingsbury Court at the time of our inspection.

There was a registered manager in post who supported us during 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 our last inspection on 11 August 2016 we identified five breaches of legislation relating to staffing, safe care and treatment, person centred care, complaints management and good governance. Following the inspection the provider wrote to tell us what they would do to meet the legal requirements in relation to the above concerns. At this inspection we found that improvements had been made in all areas which had made a positive difference to the people they support.

There were sufficient staff deployed to meet people’s needs safely. Staff had time to spend with people and the registered manager completed regular reviews of people’s needs and adjusted staffing levels where required. New staff completed an induction process which included shadowing more experienced staff members to help them understand their roles. Staff received regular training and supervision to ensure they had the skills required to meet people’s needs. Competency checks were regularly completed as part of staff induction and on-going supervision. Safe recruitment processes were in place to ensure people received support from suitable staff.

Risks to people’s safety and well-being were assessed and control measures were in place to help minimise risks. Staff were aware of how to support people to manage risks safely. Accidents and incidents were recorded and monitored to identify any trends and minimise the risk of them happening again. Staff were aware of their responsibilities in safeguarding people from potential abuse and any concerns were appropriately reported. The provider had a contingency plan in place to ensure that people’s needs would continue to be met in the event of an emergency or if the building could not be used.

Safe medicines practices were practised and people received their medicines in accordance with their prescriptions. Staff competency in managing medicines was regularly assessed. People’s healthcare needs were known to staff and appropriate referrals were made to healthcare professionals where required.

People’s legal rights were protected as staff were acting in accordance with the Mental Capacity Act 2005. Staff gained people’s consent prior to delivering care and understood the need to offer choices and respect people’s decisions. People told us they were involved in decisions regarding their day to day care.

People were supported by staff who knew their needs well and provided personalised care. People and their relatives told us that staff were caring and treated them with kindness. Care plans were person centred and contained details of people likes and dislikes. Staff supported people to maintain their independence and respected people’s privacy and dignity. People told us they enjoyed the food provided and choices were available. People’s nutritional needs were met and the catering staff were informed of people’s needs and preferences. People’s weight was monitored and appropriate action taken where significant changes were identified.

There

Inspection carried out on 11 August 2016

During a routine inspection

Kingsbury Court opened in April 2015 and provides accommodation, care and support for up to 60 people, some of whom may be living with dementia. The service is registered to provide nursing care although this area of the service had not commenced at the time of our inspection due to a staggered approach to opening the service.

The inspection took place on 11 August 2016 and was unannounced.

There was no 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 and associated Regulations about how the service is run. A manager had recently started work at the service and supported us throughout the inspection. They told us they had begun the process of registration with the Care Quality Commission (CQC) and our records confirmed this

Sufficiently skilled staff were not provided throughout the service. There was a high level of agency staff used which impacted on the care people received. The manager told us that a number of staff had recently been recruited and were currently under-going recruitment checks prior to starting work. There was a lack of leadership throughout the service which led to staff not being deployed in an organised manner to ensure people were supported safely. Staff did not receive the induction and support they required to enable them to provide effective support to meet people’s needs. Risks to people’s safety and well-being had been identified although control measures to reduce risks were not always followed.

Care plans were completed and regularly reviewed although these were found to be repetitive and did not always provide guidance to staff in how to provide people’s care. Agency staff did not have access to people’s care plans and did not have access to personalised information about the people they were caring for. Where this information was provided we found that people received care in line with their preferences. People received health care support when required although relatives told us that communication in addressing healthcare needs had led to delays in their family members receiving the support they required. We have made a recommendation regarding this.

Suitable arrangements were not in place to ensure that medicines were managed safely. Gaps were present in some medicine recording and staff did not sign records immediately following administration. Guidance for staff in the administration of ‘as and when required’ medicines were not in place and staff told us they did not always feel confident when administering medicines to people.

People, relatives and staff told us that due to a number of changes in the management of the service there was a lack of communication and leadership. They told us the new manager appeared confident and was listening to concerns. Regular audits were completed to monitor the quality of the service provided. However, where actions were identified these were not always addressed in a timely manner.

There was a system in place to deal with people's comments and complaints however we found that a number of complaints had not investigated, recorded and dealt with in line with the provider’s policy.

Staff received trained in safeguarding adults and knew how to report any concerns. They were aware of the whistleblowing policy and how to access guidance. Accidents and incidents were monitored and action taken to minimise the risk of reoccurrence. Safety checks on the environment and equipment used were completed regularly.

The provider’s recruitment procedures were robust, which helped to ensure that only suitable staff were employed. Staff completed mandatory training to support them in their role.

People told us that the quality of food was good and a choice was always available. People were supported to maintain