Kingswood Manor

Kingswood Manor provides accommodation for up to 44 people who need help with nursing or personal care. At the time of the inspection 39 people lived in the home. Some of the people living in the home lived with dementia.

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

People’s needs and risks were not adequately assessed, monitored or appropriately supported in the delivery of care. Staff lacked clear information about people’s needs and risks and records showed they did not receive the support they needed to keep them safe and well.

Accident and incidents and safeguarding events were not accurately recorded or monitored. There was little evidence that any learning from these events was shared with the staff team to prevent similar incidences from occurring in the future.

Medication management was unsafe. People did not always receive their medicines as prescribed, or in a safe way, which meant people were placed at increased risk of pain or discomfort from the conditions these medicines were intended to treat.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. People’s consent was not sought in line with the principles of the Mental Capacity Act 2005.

Infection control standards were poor. Parts of the home and its equipment were unclean, malodorous and in need of repair.

The home itself is not dementia friendly. There were no signs or pictorial aids to help people navigate around the home or dementia friendly devices to help them determine the date or time of the day. There was also a lack of any meaningful activities for people to participate in to prevent social isolation and loneliness.

Staff were not always recruited following the completion of satisfactory pre-employment checks. Some staff training was not up to date and the provider used a high number of agency staff to cover gaps in the rota.

People had mixed opinions about the staff team. Some said staff were lovely, whereas others told us some were, but others were not. Some people said that staff did not always listen to them or respect their wishes when providing care.

Staffing levels were not always safe. This impacted on the timeliness and effectiveness of people’s care. Some people told us that it was difficult to obtain staff support during the night when they needed it. It also meant the provider’s ability to keep people safe or to evacuate them to a place of safety during an emergency such as a fire was compromised.

Systems in place to monitor the quality and safety of the service were not effective and did not ensure risks to people’s health, safety and welfare were identified and managed. Managerial oversight by the manager and the provider was ineffective. This placed people at risk of avoidable harm.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was good (published 10 June 2023).

At this inspection, we found that the quality and safety of the service had significantly declined. Multiple breaches of the regulations were found, resulting in a rating of inadequate. At this inspection, breaches of regulations 9 (person centred care); 11 (Need for Consent); 12 (safe care and treatment); 17 (Good governance); 18 (Staffing) and regulation 19 (Fit and proper persons) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, were found.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This inspection was prompted by a number of safeguarding incidents reported to us by both the provider and the Local Authority which raised concerns about the safety of people’s care and the management of the service. As a result, we undertook a comprehensive inspection of the service.

We also 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 COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to the safety of people’s care and risk management, the management of medicines, environmental safety, infection control, the implementation of the mental capacity act, staffing levels, staff recruitment, staff training and the overall governance of the service.

Immediately after the inspection, we asked the provider to submit an urgent and immediate action plan for improvement. The Local Authority were also informed about our concerns to ensure people were safeguarded from potential harm.

We also placed conditions on the provider’s registration with a clear requirement to immediately improve aspects of people's care and treatment which continued to place them at risk.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service has been placed in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

Kingswood manor provides accommodation and nursing and/or personal care to up to 44 people, some of whom are living with dementia. At the time of our inspection there were 36 people living in the home.

People's experiences of using this service and what we found

Risks to people's health, safety and well-being had been identified through assessments and detailed care plans provided staff with the relevant information and guidance to help support people safely. People's medicines were managed safely by staff who had the relevant skills, training and experience to safely administer prescribed medicines.

Staff received safeguarding training and were able to explain what action they would take if they had any concerns. People told us they felt safe living at Kingswood Manor. Accidents, incidents and safeguarding concerns were acted upon appropriately and the registered manager reviewed incidents to look at ways to prevent them in the future.

There were enough staff on duty to support people safely. Newly recruited staff were subject to a range of pre-employment checks to ensure they were suitable to work for the service.

The home and equipment used to support people with their mobility needs was clean and hygienic. Staff responsible for the cleanliness of the home kept detailed records of the tasks they had completed.

People received care that was person-centred and based on their individual needs and choices. Staff knew people well and how to support them in line with their needs and preferences. People had access to a range of activities and were supported to maintain contact with those important to them.

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.

Governance systems were effective at identifying issues and driving improvements to the overall safety and quality of the service provided. Staff spoke positively about the registered manager and the increase in staff moral and support since they were recruited.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 October 2022) and there was a breach of regulations. The provider completed and action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the standard of care people received. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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 COVID-19 and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kingswood Manor is a care home providing nursing and personal care for up to 40 people, some of whom are living with dementia. There were 25 people living in the home at the time of the inspection.

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

We identified issues of concern with Infection prevention and control practices in relation to visitors recording current health on entry to building, cleaning high touch points and some areas of the main kitchen.

We recommended the provider review their visiting procedures and review further quality assurance checks for continuous improvement.

We recommended the provider continues to implement and review quality assurance checks for continuous and sustained improvements.

Care records were individualised and reflected each person's needs and preferences. Risks were assessed and identified, and staff had guidance to help reduce the risk of avoidable harm to people they were supporting. However, we did find key missing details in personal emergency evacuation plans that we looked at.

Staffing levels were appropriate. However due to current difficulties recruiting new staff, the home used a moderate volume of agency staff. The provider did show us that they were taking action to recruit more permanent staff.

People were protected from abuse because staff understood the correct procedure to follow if they had any concerns. Staff were knowledgeable about people's health needs and the provider worked in partnership with other health professionals as a measure of providing the appropriate level of support.

The provider had addressed issues identified from the last inspection and internal quality assurance audits relating to the medicine’s, environment, fire safety and care records.

People received their medicines as prescribed. These were stored and disposed of safely.

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 Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Inadequate (published 03 May 2022). At this inspection we found that although some improvements had been made, the provider remained in breach of regulation regarding infection prevention and control measures.

Exiting special measures

This service has been in Special Measures since [03 May 2022]. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection on 14 and 23 September 2022 following on from breaches that were found at the previous inspection in May 2022. The provider completed an action plan after the last inspection to show what they would do and by when to make improvements.

We undertook this focused inspection to check improvements had been made and if the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kingswood Manor on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kingswood Manor is a residential care home providing personal and nursing care to up to 44 people. The service provides support to older people, some who live with dementia. At the time of our inspection there were 36 people using the service.

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

The provider failed to ensure people were consistently protected from avoidable harm. Areas of the environment were unhygienic and had not been suitably maintained. We found shortfalls in the management of food hygiene standards, fire safety and the emergency call bell system.

Staff did not always ensure people received their medicines as prescribed. The provider failed to effectively quality assure how medicines were managed and this meant people were exposed to the risk of harm. For example, time specific medicines were not always given as prescribed and we could not be sure people received their creams and ointments.

Staff did not always follow safe infection prevention and control processes. People were exposed to the risk of transmitting infectious disease, including COVID-19.

The provider and manager failed to identify the shortfalls found at this inspection. Quality assurances systems were not effective and the home was not well-led.

The provider and manager did not always ensure people received person-centred care and treatment. We found people did not always receive their medicines in a person-centred way and decisions made were not always carried out in liaison with the person or their representative.

The provider did not always keep a record of agency worker induction. Shift leaders told us agency workers were inducted and shown emergency procedures however, they had failed to keep a record. The provider did ensure new applicants were screened for good character before they were recruited.

People and their representatives told us they felt safe and well cared for. We observed people had built trusting relationships with staff. People had access to stimulating activities and encouraged to maintain contact with friends and family.

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 31 October 2019).

At our last inspection we recommended the provider look at improved ways to manage the deployment of staff and medicines. At this inspection we found the provider had acted on the staff deployment recommendations and improvements had been made. However, the provider had not made sufficient progress in safe management of people’s medicines.

Why we inspected

We received concerns in relation to the management of medicines, accident and incidents and person-centred care. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, person-centred care, medicines management, environment safety, infection control and governance at this inspection. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

• A safe visiting procedure was in place and followed. Any visitors to the service had their temperature taken and completed a health screening questionnaire. During periods of lockdown, visits were facilitated in exceptional circumstances.

• The service was registered for regular testing to ensure people and staff were tested frequently.

• Policies, procedures and equipment were in place to maintain infection control and support the needs of the people using the service. The registered manager acted as the lead for infection prevention and control.

We have made a recommendation that the service minimises movement of staff between care homes.

Kingswood Manor is a care home providing accommodation for up to 44 older people, including people living with dementia. At the time of the inspection there were 41 people living at the home.

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

We inspected the home on 21 September 2020 to see how care was being provided against information of concern we had received.

Staff were not always deployed in the most effective way. Whilst staff rotas and staff dependency tools showed there were enough staff, people told us that staff were often busy and there wasn’t always enough of them.

People told us this meant they could not always have a shower when they wanted as the staff "didn’t have time." Some people told us they did not always have a choice in what time they got up and went to bed, as again this depended upon how busy staff were.

We have made a recommendation about the deployment of staff.

Medications were not always administered in a safe way. Some people told us that staff who gave them their tablets, left them with their medication, as "staff knew they were able to take it themselves."

We have made a recommendation about the management of medicines.

Whilst most people told us staff were kind and caring, some people told us some staff were more caring and compassionate than others. People told us they were not always supported to have genuine choices about their care and support as ''staff were rushed off their feet.''

People told us there wasn’t always enough to do during the day but they appreciated that "staff tried their best.’’

The registered manager was working closely with the area manager team to address staff deployment and recruit an activity co-ordinator to facilitate both activities and communication between people and their loved ones during periods of restricted visiting.

We found people were protected from the risk of acquiring infections such as Covid-19 and the service was clean. Personal protective equipment was readily available to staff and all staff were following the latest guidance.

Rating at last inspection

The last rating for this service was Good (published 31 October 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staff deployment, unsafe administration of medication, concerns about people’s care and dignity and governance. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We found no evidence during this inspection that people were at risk of harm from these concerns.

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. Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingswood Manor 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.

Kingswood Manor is a large grade two listed building situated in Liverpool. The service supports older people, a few of whom are living with dementia and people with nursing needs. The service can accommodate up to 44 people. At the time of the inspection, there were 40 people living at the home.

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

We discussed with the registered manager that some of the care plans varied in their level of personalised information and consistency and were not always detailed with regards to people’s specific needs. The provider had identified shortfalls in people’s care plans and was in the process of implementing a new care planning system. We have made a recommendation about involving people in their care plans and reviews as this was not always evident.

Complaints were well documented and responded to, and end of life care was treated sensitively.

Everyone told us they felt safe living at the home. Medication was well managed, stored and administered in line with the legislative requirements. Risk assessments were in place and risks were assessed and reviewed. The environment was subject to regular checks, and staff recruitment remained safe. There were enough staff on shift to provide safe care.

The service contacted the GP and made referrals to ensure people’s healthcare needs were taken care of. Staff were trained and engaged in supervision. 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's eating and drinking needs were assessed and where additional support was needed this was in place.

People’s confidentially was respected, and we saw numerous caring interactions between staff and people who lived at the home. It was clear people knew the staff well, there was good relationships between people and the staff. We received positive comments regarding the caring nature of the staff. People told us they were given choice and treated with dignity and respect.

There were effective systems in place to check the quality and safety of the service. Checks were in place that covered a range of key aspects they had identified within the care plans and management of medication. The registered manager was responsive to this and had implemented actions to address this. Positive feedback had been received regarding the registered manager and their ability to run the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was good. (Published 19 May 2017).

Why we inspected

This was a planned inspection.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Kingswood Manor is a period building in its own grounds. It is registered to provide accommodation for persons who require nursing or personal care to up to 44 people; there were 42 people living at the home at the time of this inspection. The building has two upper floors which contained most people’s rooms, a ground floor which mainly contained the communal lounge and dining room as well as offices and another two bedrooms for people nearing their end of life. There was a large basement area which contained the kitchen. A passenger lift gave to access all floors as well as a central stairway.

The home required 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. There was a registered manager in place who had been in post for several years.

At our previous inspection on 04 and 09 November 2015, we had found breaches of regulations 12 and 17 of the Health and Social Care Act 2008 in respect to safe care and treatment and the lack of suitable quality assurance processes. The home then undertook to immediately address these concerns. At this inspection we found that the home had made the required improvements immediately after that inspection and we saw that they had been sustained.

We toured the home and noted that most of the carpeting had been replaced and rooms and communal areas redecorated. We looked at records relating to the safety of the premises and its equipment, which we saw were recorded as being checked and safe. The records showed that the required safety checks for gas, electric and fire safety were carried out.

People received sufficient quantities of food and drink and had a choice in the meals that they received. Their satisfaction with the menu options provided had been checked. Where people had lost weight this was recognised with appropriate action taken to meet the person’s nutritional needs.

Menus were flexible and alternatives were always provided for anyone who didn’t want to have the meal on the menu for that day. People we spoke with said they always had plenty to eat. We joined the lunch time meal where staff were observed to support people to eat and drink with dignity.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA) when providing care. The staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans and risk assessment monthly review records, were all up to date in the files, we looked at and there was updated information that reflected the changes of people’s health.

People told us they felt safe with staff and this was confirmed by people’s relatives who we spoke with. The registered manager had a good understanding of safeguarding. The registered manager had responded appropriately to allegations of abuse and had ensured reporting to the local authority and the CQC as required.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We looked at rotas for shifts throughout the day and night. Staffing levels were seen to be appropriate. All the people and their visitors we spoke with considered there were adequate staff on duty. People were able to have person centred, 1-1 activities provided, to promote their wellbeing.

The home used safe systems for recruiting new staff. These included using Disclosure and Barring Service (DBS) checks and annual self-disclosure checks made with the manager. The staff files did not include a photograph of the staff. A photograph is a useful way of checking staff’s identification and can verify other documentation, such as passports and visas. There was an induction programme in place which gave staff the basic skills to ensure they were competent in the role they were doing at the home. Further training and refresher training was provided according to each staff member’s role. Staff told us they felt supported by the deputy manager and the registered manager.

We found that the medication administration procedures followed the home’s policies. The medication room was secured whilst not in use. Medication tallied with the records.

There were no recent complaints about the home. Where there had been complaints, these were dealt with effectively and followed the home’s complaints policy. Quality assurance systems had been improved and reflected the current situation with the home and used action plans to monitor and improve systems.. The registered manager of Kingswood Manor had been supported to make improvements and to sustain these, by the provider and we found there was good support from them for the home to continue to improve.

People were able to see their friends and families when they wanted. Visitors were seen to be welcomed by all staff throughout the inspection.