17 November 2020
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
As part of CQC’s response to the coronavirus pandemic we are conducting a thematic review of infection control and prevention measures in care homes.
The service was selected to take part in this thematic review which is seeking to identify examples of good practice in infection prevention and control.
This inspection took place on 22 October 2020 and was announced.
17 November 2020
About the service
Kingswood House is a residential care home registered to provide personal and nursing care for up to 26 older people, including people living with dementia. At the time of the inspection 18 people were using the service.
People’s experience of using this service and what we found
Since the last inspection changes in management had caused some disruption in the systems to manage oversight on quality at the service. At the time of this inspection a new manager had taken up post and an application to register with the Care Quality Commission (CQC) was in progress. The manager had previously worked at a senior level at the service and understood the needs of the service. The provider visited the service on a regular basis, they were very receptive and pro-active in response to the findings of this inspection.
Staff recorded accidents and incidents, but a system to reflect and analyse the reports for any trends or themes was not in place. Following the inspection, the provider implemented a monthly accident and incident audit system.
Information was contained in people’s care plans about meeting their oral care needs. But further work was needed to increase staff knowledge in this area. Following the inspection, the provider arranged for specific oral care training, and put in place oral care assessments and monthly audits. They had also met with a dentist to arrange for domiciliary dental visits to take place at the service.
The provider had an open-door policy, they said family members and people who use the service chose not to go through the formal complaint channels. However, they did not have an effective system in place to demonstrate the actions they had taken to address any concerns or complaints. Following the inspection, the provider placed literature on the complaints policy on display and implemented systems to record all concerns and complaints brought to their attention and their actions taken in response.
Having the above systems embedded into practice will enable the provider to identify where quality and/or safety may be compromised; to respond appropriately and without delay.
A range of individual risk assessments were in place that identified areas where people needed support to manage their safety. For example, risks of falls or skin tissue damage due to poor mobility and frailty. The assessments detailed the controls and equipment in place to reduce and manage the risks to an acceptable level.
Staff knew their roles and responsibilities in relation to keeping people safe. The provider co-operated with the local safeguarding authority in response to safeguarding concerns and investigations had taken place.
The staffing numbers were appropriate to meet the needs of people using the service. The provider closely monitored staffing levels to ensure they were suitable to meet people’s needs. Appropriate recruitment checks were completed, which included checks for any criminal convictions, and satisfactory employment references were obtained before staff started working at the service.
People received their medicines in line with the medicines policy and procedures. Staff received appropriate training and their competency to administer medicines was assessed. Regular medicines audits took place and any issues were dealt with in a timely way. Medicines reviews were carried out with the GP to ensure prescribed medicines were appropriate to people’s needs.
Staff received infection control training and understood the importance of using protective personal equipment (PPN) such as, gloves and aprons. Information was on display to remind people of the importance of good hand washing techniques.
Staff training records demonstrated mandatory health and safety training was provided to all staff and training to meet the specific needs of people using the service. Staff received regular supervision to discuss their work and learning and development needs.
People were supported to maintain a healthy balanced diet. People at risk of not eating and drinking enough were referred to the relevant healthcare professionals. People at risk of dehydration had fluid monitoring charts in place. However, the systems to check people received the recommended daily amount of fluids needed improving. The provider took immediate action by introducing a system to ensure people’s food and fluid monitoring charts were checked daily. This meant timely action could be taken to encourage people to increase their diet and hydration or when to seek medical advice.
People's needs were assessed, and people and their relatives were involved in the care reviews. People had regular access to healthcare professionals and staff sought support from health professionals in response to any deterioration in their health. Records showed that prompt referrals were made, for example to the GP and speech and language therapist and the staff followed the advice from healthcare professionals.
Routine health and safety audits and fire systems checks took place. Each person had a personal evacuation plan (PEEP) in place. Equipment used to support people to move, such as hoists were regularly maintained. A programme of redecoration, repairs and refurbishments was in place.
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.
All the people spoken with said they were pleased with the care they received. People's individuality was promoted and respected. People were encouraged to express their views and to make choices. People had formed positive relationships with staff and their privacy and confidentiality was maintained.
People’s care plans contained sufficient detail to guide staff on the care and support people required. They were reviewed regularly, and any changes were communicated to the staff team to keep them fully appraised of people's current needs. The provider was aware of the requirement to provide people with accessible information, we saw that information was provided in large print. Staff were aware of people with sensory, sight and hearing loss, and how they communicated.
A range of activities were provided for people. People were supported to maintain relationships with friends and family and there were no restrictions on visiting times. Staff received training on end of life care to ensure people were provided with the right support to have a comfortable, dignified and pain-free death.
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 23 June 2017).
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.