Archived: Kingswood Manor

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Staff spoken with understood the importance of providing person centred care. We saw that people’s care plans contained person centred information about their wishes and preferences and staff spoken with knew people well.

However, people’s individual needs and risks had not always been fully assessed which impacted on the ability of staff to deliver person centred care. Some information about people’s individual care needs was contradictory, as care plans had not been updated appropriately when people’s needs had changed. For example, one person’s care record stated they were both continent and incontinent; another person’s care records stated the person was prescribed thickening medicine when they were not. One person’s nutritional regime differed across different care plans because it had not been updated properly. This lack of clear and consistent information placed people at risk of inappropriate care.

People did not receive person centred care from nursing staff. The management of medicines did not ensure people’s individual health conditions received the treatment they needed to prevent harm. Where changes were made to people’s medicines, changes were not acted upon appropriately by the nursing team to ensure people’s need were met. These shortfalls were identified at the last 2 assessments, yet no effective action had still been taken to ensure people received person centred clinical care. This placed people at risk of avoidable harm.

The environment in which people lived did not maximise person centred care by promoting a sense of well-being or by helping people to make sense of their surroundings.For example, dementia friendly signage around the home remained poor which impacted on people’s ability to be find their way around the home and their own bedroom independently. We raised this at the last 2 assessments, but no action had been taken to improve the environment for people living with dementia.

Most people living in the home spent most of their day in the communal lounge. This environment did not promote good outcomes for people, particularly those people living with dementia. The lounge had two televisions situated at opposite end of the room. The televisions were set on the same channel but were out of synch which meant one television was slightly behind the other in terms of its picture and sound. This was very distracting, and made listening to either television confusing and difficult. This increased the risk of people experiencing sensory overload, distress and anxiety.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined up, flexible, or supportive of choice or continuity.

Referrals to other health and social care professionals were made in support of people’s needs. People’s care was also discussed at the weekly multidisciplinary meeting with the home’s registered GP, community matron and other professionals. People’s care records were not always updated with the advice given or action taken following these multi-disciplinary meetings.

At the last two assessments of this service, when professional advice had been given, it was not always followed. At this assessment no improvements had been made. For example, one person’s nutritional regime which included safety guidance had not been followed by nursing staff. Nursing staff had not ensured the manufacturers or prescriber’s instructions for the administration of some medicines had been followed.

A visiting professional told us, “Things have improved, we have regular multi-disciplinary team meetings, and the staff do attend. There is improvement needed with the communication. I don’t think it’s always great, last week in the multidisciplinary meeting, I asked for a fit test to be completed, and I’ve come in today and it still hasn’t been completed by the nursing staff”.

The provider did not demonstrate they fully understood the mental health needs of people living with dementia. Dementia care planning remained poor and the environment was not dementia friendly.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s care records contained information about their communication needs. However, care plans did not always provide clear information about the hand gestures, sounds or facial expressions some people may use to express consent, pain or other emotions. This was the same at the last 2 assessments.

Most of the information in the home was in written format. For example, complaints procedure, service user/relative meeting minutes. Picture cards were available in the home, but staff confirmed these were not used with anyone in the home to help them communicate. No picture menus were available to help people recognise and choose their mealtime options. Signage around the building failed to provide adequate information on where the person was in the building or how to navigate around it.

There remained a lack of formal consent provisions around the taking of photographs and the sharing of people’s personal information with other people, including family and other health and social care professionals.

Relatives told us they were kept informed of any changes in their loved one’s health and contacted if there was an emergency. One relative told us, “The communication is great I get updates all the time”. Resident and relative meetings also took place with the registered manager and staff from the service to share information and gain feedback on the service. A relative told us, “They invite us for regular meetings and to get our feedback, the place is much more organised".

The provider did not always make it easy for people with communication difficulties to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

A service user/relatives meeting took place regularly to enable people to share their views and ideas for service improvements. Most people felt able to share their feedback on the service and raise any concerns. Relatives confirmed this. A visiting professional told us, “The manager always gets back to me if I need anything. I spoke to the management team about a concern it was dealt with”.

There were continued concerns however with regards to how people with communication difficulties were actively supported to be involved in their care and how they were encouraged to share feedback and ideas. Picture aids were not in use. No other communication tools were available, for example an iPad, or touchscreen laptop and information about people’s communication methods were not always clearly described.

There was a written complaints procedure in place. Any formal complaints received by the registered manager or regional manager had been responded to appropriately.

People’s care was reviewed monthly, but review records were brief and did not demonstrate people were actively involved in this process.

The provider made sure that people could access the care, support and treatment from other services when they needed it.

There were processes in place to ensure people were referred equitably to other health and social care professionals. This included referrals to tissue viability services, occupational therapy, mental health, dieticians, speech and language therapy and district nurses.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Equality, diversity and human rights policies were in place to make sure people were treated fairly, regardless of their age, sex, race, disability or religious belief. Staff had completed training in equality and diversity and understood people had a right to be treated fairly and equally.

People’s care plans included information on their personal characteristics, wishes and preferences to ensure their equality and diversity was respected. We observed staff respecting these during our visit. People had equal access to the home’s social activities and people spoke positively of these activities. It was clear the activity experience was a positive one.

No improvements to enable people living with communication difficulties or dementia to communicate their concerns or needs had been made since the last 2 assessments. People’s experience of medicines also continued to be inequitable as some people did not receive the medicines they needed to meet their individual needs or to support them to achieve positive outcomes.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Since our last assessment, some clarity had been obtained on people’s end of life wishes and whether they wished to discuss them at the present time. We saw that where people did not wish to discuss this element of their care, this was respected. However, the end of life care plans in place for some people with long term health conditions remained generic, and did not clearly document their individual wishes and preferences. This continued to compromise the ability of staff to provide person centred care at the end of people’s lives.

There continued to be a process in place to ensure people’s advance decisions in respect of cardio-pulmonary resuscitation (CPR) were documented. The correct legal process in relation to CPR decisions had been followed where people did not have capacity to consent to these arrangements.

Staff members had completed training in end of life care.