Archived: Kingsmead House Care Home

There was a manager in post; however they were not yet registered with CQC. An interview date was pending. 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 told us that they felt safe, however, the provider had been issued with an Enforcement Notice from the Fire Service. The provider told us that the works would be completed by the end of June 2017.

There were sufficient staff to keep people safe. There were recruitment practices in place to ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records. For people who had ‘as required’ medicine, there were guidelines in place to tell staff when and how to administer them.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks such as falls and moving and handling. The manager ensured that actions had been taken after incidents and accidents occurred to reduce the likely hood of them happening again.

There were mixed views about activities. Improvements had been made since the last inspection. There was an activity programme in place. The manager recognised that further work needed to be done in this area.

Improvements had been made in the home, however further work was needed with record keeping, ensuring that care records were fully completed and were personalised.

People’s human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people lacked capacity to make some decisions, mental capacity assessment and best interest meetings had been undertaken, however they lacked details. Staff were heard to ask people’s consent before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. Staff received regular supervision and an annual appraisal.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

People’s choices and views were respected by staff. Staff and the management knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. Care plans contained information for staff to support people effectively. However, it was not always evidence that people and their relatives had been involved in care planning. We have made a recommendation.

The home listened to staff and people. Some relatives told us that this was inconsistent. There was a complaints procedure in place. Complaints had been responded to in line with the provider’s complaints procedure.

The management promoted an open and person centred culture. Staff told us they felt supported by the management and that they were approachable. Relatives and people told us that they had seen improvements in the care provided however there were still some inconsistencies. Improvements could be made with some care records. We have made a recommendation.

There were procedures in place to monitor and improve the quality of care provided. The management understood the requirements of CQC and sent in appropriate notifications.

We carried out an unannounced comprehensive inspection of this service on 7 September 2016. At this inspection breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches of good governance and provider management oversight by 28 November 2016.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

While improvements had been made in some areas, we found that sufficient action had not been taken to meet the breaches in the regulations.

The registered manager had not ensured that action was taken once an area of improvement was identified. There were not always sufficient staff to meet people’s needs. The registered manager had identified a need for twilight staff (7-11pm) to support people with tasks such as going to bed or eating supper. Although they had identified this need, they had not implemented any staff changes. The registered manager had also deployed care staff to be taken off shift to provide drinks to people which could take up to one hour at a time, meaning other people had to wait for their care needs to be met.

The registered manager did not have a system in place to ensure that record keeping was accurate and up to date. There were some improvements made in managing risks to people. Some people had risk assessments in place that identified and managed risks. Further improvement was required around the record keeping and the accuracy of the information to meet people’s needs. This lack of appropriate record keeping could lead to people’s health deteriorating and staff not being aware of it.

People had care plans in place that contained information on specific nursing treatments such as wound care. They contained information on people’s likes and dislikes. However not all people had up to date and personalised care plans. Care plans lacked information on people’s health conditions and how they impacted on their well being. This meant that staff may not always know how to care for a person effectively.

There were some new systems in place to monitor, review and improve the quality of care. However they did not always identify areas of concern, they were not robust and did not cover all aspects of care. The progress of improvement was slow.

The service was not always well led. Staff felt that they were not always able to approach the registered manager. Staff told us they felt they were not listened to and action was not always taken by the registered manger about their concerns.

The registered manager had introduced a system to ensure that staff received supervision. There was more training for staff, however improvements could be made. Staff lacked training in specific health conditions that people had, which meant that people’s needs may not always be understood. Staff had a great understanding of their roles and responsibilities could be made. Staff had a great understanding of their roles and responsibilities.

The registered manager had now made improvements to ensure staff were recruited safely.

We found a continued breach of Regulation 17 in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what we told the provider to do at the back of the report.

Kingsmead Care Home House Care Home is a nursing home for up to 40 people, with a range of support needs including personal care, nursing needs and for people who require end of life care. On the day of our inspection there were 24 people living at the home.

The previous registered manager left the home on 22 February 2016 and the new manager began on 1 April 2016 and they are now registered. 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.

Kingsmead House Care Home was last inspected on 11 January 2016, where it was rated overall as ‘Requires Improvement’, with well led rated as ‘Inadequate’. Six breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. These related to personalised care, risk management, training and supervision, complaints, safe guarding and quality monitoring. Requirement action were set in relation to these and the registered provider sent us a report that details steps that would be taken to make the required improvements. At this inspection we found that although initially the provider had taken steps to address the requirement actions these had not been sustained and issues remained in four areas.

People told us that they felt safe. Despite this risks to people were not always managed. Some risks to people had been identified but there was no management plan in place, although no harm came to people. Some people had risk management plans in place.

Training and staff’s knowledge had improved. However staff did not always receive regular supervision according to the homes policy. Staff were not always aware of their roles and responsibilities. There was a lack of leadership and management of each shift. The registered manager did not always ensure that staff had the skills and competence to support people effectively.

For people who had nursing needs, for some people there were not always care plans in place. Care plans that were in place were not always personalised and did not contain people’s personal history.

The home was not always well led. The registered manager and provider had not ensured that there were robust quality assurance processes in place to monitor, evaluate and improve care. The pace of improvement was slow. However, staff and people told us that the registered manager was approachable and supportive.

People and relatives told us there were not always enough staff effectively deployed to support people with their care needs. Staff were not always recruited safely; however DBS, nurses’ checks and right to work in the UK checks were completed.

People’s medicines were stored and disposed of safely. However people’s medicines were not always administered safely. For people who had PRN (as required) medicines, staff did not always have guidelines in place to know when and how to administer the medicine. We made a recommendation.

People’s human rights were protected as the registered manager had ensured that the requirements of the Mental Capacity Act were followed. For people that lacked capacity to make decisions there was not always a mental capacity assessment completed and a best interest decision made. Where people were deprived of their liberty, the registered manager had ensured that DoLS applications had been made to the local authority.

People and their relatives told us that staff were caring and kind. However people were not always involved in planning their care. Productive relationships had been formed, however with the high use of agency staff consistency of care could not always be provided.

There was an activity programme in place. However some people missed out on opportunities as the heard about them too late. Trips out occurred, but this often meant that the majority of people missed out on an activity.

People felt listened to. People were aware of how to make a complaint. The registered manager did not always record actions taken. The registered manager had implemented a suggestions box which was used regularly. Residents and relatives meetings occurred quarterly.

Staff had knowledge of safe guarding procedures. There was a whistleblowing policy in place. The registered manager ensured that they alerted the local safe guarding team and CQC and took action to minimise risks of harm when required.

Staff knew how to manage accidents and incidents. The registered manager had oversight of incidents and accidents and took action when required. There was a contingency plan in place to support staff when there was an emergency.

People told us they liked the food. People had sufficient to eat and drink. People were seen to be offered choice of what they would like to eat and drink. Relatives and friends could eat meals with people.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

We last inspected the home on 11 January 2016, where we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On this inspection there were a number of continued breaches and one new one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Kingsmead House Care Home is a nursing home for up to 40 people, with a range of support needs including personal care, nursing needs and for people who require end of life care. On the day of our inspection there were 26 people living at the home.

The home was run by a registered manager, who was present for part of the day of the inspection visit. ‘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.

People were not always protected from harm and ill treatment. Not all staff had training in safe guarding people; therefore not all care staff were always able to keep people safe.

People were not always protected from potential risks. Some risks to people had been identified but there was no management plan in place. Risk assessments were not always reviewed for people when their needs changed.

People were not always supported at their end of life to have a comfortable and dignified death. Pain assessments were not always in place. People’s wishes and views were not routinely obtained; this meant that the staff could not always care for people how they wanted.

People often had to wait to get their as required pain relief medicines. People’s medicines were not always managed and administered safely. Medicines were stored and disposed of safely.

People did not always receive effective care. The registered manager had not always ensured that staff had the training, knowledge; skill and regular supervision to enable to them care for people safely and effectively. Some new care staff had not received induction training, which included mandatory training such as fire safety, mental capacity and safe guarding people.

Peoples care plans often missed out vital information as to how to care for people with specific health needs. Care plans were not personalised.

People’s views were not routinely listened too. People, their relatives and health professionals told us they raised concerns and complaints to the registered manager and they had not been dealt with.

There were no robust systems in place to monitor, review and improve on the quality of care. The registered provider and registered manager lacked oversight of the quality of care being delivered.

Recruitment procedures were not always followed as the registered manager did not always ensure that staff were of good character as references were not always obtained prior to employment. The registered manager had ensured staff had DBS checks had been completed prior to starting employment at the home.

People’s human rights could have been affected because the requirements of the Mental Capacity Act were not always followed. For people that lacked capacity to make decisions there was not always a mental capacity assessment completed and a best interest decision made.

The registered manager had recently increased the staffing levels in the home, as people and professionals had raised concerns there were not enough staffing. People told us that staffing levels were improved.

People’s care would not be interrupted in the event of an emergency if people needed to be evacuated from the home as staff had guidance to follow. Staff knew how to respond to accidents and incidents.

People were supported to have sufficient food and drink. People told us the food was good and there was choice. People were supported to maintain their health by accessing external health professionals such as GP and community matrons.

Staff were caring. Staff had developed positive relationships with people and were kind and considerate. People’s dignity and privacy was respected.

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